Module: DZero::Utils::RejectionCodes

Defined in:
lib/dzero/utils/rejection_codes.rb

Constant Summary collapse

REJECTION_CODES =
{
  "1"  => :missing_or_invalid_bin,
  "2"  => :missing_or_invalid_version_number,
  "3"  => :missing_or_invalid_transaction_code,
  "4"  => :missing_or_invalid_processor_control_number,
  "5"  => :missing_or_invalid_pharmacy_number,
  "6"  => :missing_or_invalid_group_number,
  "7"  => :missing_or_invalid_cardholder_id_number,
  "8"  => :missing_or_invalid_person_code,
  "9"  => :missing_or_invalid_birth_date,
  "10" => :missing_or_invalid_patient_gender_code,
  "11" => :missing_or_invalid_patient_relationship_code,
  "12" => :missing_or_invalid_patient_location,
  "13" => :missing_or_invalid_other_coverage_code,
  "14" => :missing_or_invalid_eligibility_clarification_code,
  "15" => :missing_or_invalid_date_of_service,
  "16" => :missing_or_invalid_prescription_service_reference_number,
  "17" => :missing_or_invalid_fill_number,
  "19" => :missing_or_invalid_days_supply,
  "1C" => :missing_or_invalid_smoker_non_smoker_code,
  "1E" => :missing_or_invalid_prescriber_location_code,
  "20" => :missing_or_invalid_compound_code,
  "21" => :missing_or_invalid_product_service_id,
  "22" => :missing_or_invalid_dispense_as_written_daw_product_selection_code,
  "23" => :missing_or_invalid_ingredient_cost_submitted,
  "25" => :missing_or_invalid_prescriber_id,
  "26" => :missing_or_invalid_unit_of_measure,
  "28" => :missing_or_invalid_date_prescription_written,
  "29" => :missing_or_invalid_number_refills_authorized,
  "2C" => :missing_or_invalid_pregnancy_indicator,
  "2E" => :missing_or_invalid_primary_care_provider_id_qualifier,
  "32" => :missing_or_invalid_level_of_service,
  "33" => :missing_or_invalid_prescription_origin_code,
  "34" => :missing_or_invalid_submission_clarification_code,
  "35" => :missing_or_invalid_primary_care_provider_id,
  "38" => :missing_or_invalid_basis_of_cost,
  "39" => :missing_or_invalid_diagnosis_code,
  "3A" => :missing_or_invalid_request_type,
  "3B" => :missing_or_invalid_request_period_date_begin,
  "3C" => :missing_or_invalid_request_period_date_end,
  "3D" => :missing_or_invalid_basis_of_request,
  "3E" => :missing_or_invalid_authorized_representative_first_name,
  "3F" => :missing_or_invalid_authorized_representative_last_name,
  "3G" => :missing_or_invalid_authorized_representative_street_address,
  "3H" => :missing_or_invalid_authorized_representative_city_address,
  "3J" => :missing_or_invalid_authorized_representative_state_province_address,
  "3K" => :missing_or_invalid_authorized_representative_zip_postal_zone,
  "3M" => :missing_or_invalid_prescriber_phone_number,
  "3N" => :missing_or_invalid_prior_authorized_number_assigned,
  "3P" => :missing_or_invalid_authorization_number,
  "3R" => :prior_authorization_not_required,
  "3S" => :missing_or_invalid_prior_authorization_supporting_documentation,
  "3T" => :active_prior_authorization_exists_resubmit_at_expiration_of_prior_authorization,
  "3W" => :prior_authorization_in_process,
  "3X" => :authorization_number_not_found,
  "3Y" => :prior_authorization_denied,
  "40" => :pharmacy_not_contracted_with_plan_on_date_of_service,
  "41" => :submit_bill_to_other_processor_or_primary_payer,
  "4C" => :missing_or_invalid_coordination_of_benefits_other_payments_count,
  "4E" => :missing_or_invalid_primary_care_provider_last_name,
  "50" => :non_matched_pharmacy_number,
  "51" => :non_matched_group_id,
  "52" => :non_matched_cardholder_id,
  "53" => :non_matched_person_code,
  "54" => :non_matched_product_service_id_number,
  "55" => :non_matched_product_package_size,
  "56" => :non_matched_prescriber_id,
  "58" => :non_matched_primary_prescriber,
  "5C" => :missing_or_invalid_other_payer_coverage_type,
  "5E" => :missing_or_invalid_other_payer_reject_count,
  "60" => :product_service_not_covered_for_patient_age,
  "61" => :product_service_not_covered_for_patient_gender,
  "62" => :patient_card_holder_id_name_mismatch,
  "63" => :institutionalized_patient_product_service_id_not_covered,
  "64" => :claim_submitted_does_not_match_prior_authorization,
  "65" => :patient_is_not_covered,
  "66" => :patient_age_exceeds_maximum_age,
  "67" => :filled_before_coverage_effective,
  "68" => :filled_after_coverage_expired,
  "69" => :filled_after_coverage_terminated,
  "6C" => :missing_or_invalid_other_payer_id_qualifier,
  "6E" => :missing_or_invalid_other_payer_reject_code,
  "70" => :product_service_not_covered,
  "71" => :prescriber_is_not_covered,
  "72" => :primary_prescriber_is_not_covered,
  "73" => :refills_are_not_covered,
  "74" => :other_carrier_payment_meets_or_exceeds_payable,
  "75" => :prior_authorization_required,
  "76" => :plan_limitations_exceeded,
  "77" => :discontinued_product_service_id_number,
  "78" => :cost_exceeds_maximum,
  "79" => :refill_too_soon,
  "7C" => :missing_or_invalid_other_payer_id,
  "7E" => :missing_or_invalid_dur_pps_code_counter,
  "80" => :drug_diagnosis_mismatch,
  "81" => :claim_too_old,
  "82" => :claim_is_post_dated,
  "83" => :duplicate_paid_captured_claim,
  "84" => :claim_has_not_been_paid_captured,
  "85" => :claim_not_processed,
  "86" => :submit_manual_reversal,
  "87" => :reversal_not_processed,
  "88" => :dur_reject_error,
  "89" => :rejected_claim_fees_paid,
  "8C" => :missing_or_invalid_facility_id,
  "8E" => :missing_or_invalid_dur_pps_level_of_effort,
  "90" => :host_hung_up,
  "91" => :host_response_error,
  "92" => :system_unavailable_host_unavailable,
  "95" => :time_out,
  "96" => :scheduled_downtime,
  "97" => :payer_unavailable,
  "98" => :connection_to_payer_is_down,
  "99" => :host_processing_error,
  "A9" => :missing_or_invalid_transaction_count,
  "AA" => :patient_spenddown_not_met,
  "AB" => :date_written_is_after_date_filled,
  "AC" => :product_not_covered_non_participating_manufacturer,
  "AD" => :billing_provider_not_eligible_to_bill_this_claim_type,
  "AE" => :qmb_qualified_medicare_beneficiary_bill_medicare,
  "AF" => :patient_enrolled_under_managed_care,
  "AG" => :days_supply_limitation_for_product_service,
  "AH" => :unit_dose_packaging_only_payable_for_nursing_home_recipients,
  "AJ" => :generic_drug_required,
  "AK" => :missing_or_invalid_software_vendor_certification_id,
  "AM" => :missing_or_invalid_segment_identification,
  "B2" => :missing_or_invalid_service_provider_id_qualifier,
  "BE" => :missing_or_invalid_professional_service_fee_submitted,
  "CA" => :missing_or_invalid_patient_first_name,
  "CB" => :missing_or_invalid_patient_last_name,
  "CC" => :missing_or_invalid_cardholder_first_name,
  "CD" => :missing_or_invalid_cardholder_last_name,
  "CE" => :missing_or_invalid_home_plan,
  "CF" => :missing_or_invalid_employer_name,
  "CG" => :missing_or_invalid_employer_street_address,
  "CH" => :missing_or_invalid_employer_city_address,
  "CI" => :missing_or_invalid_employer_state_province_address,
  "CJ" => :missing_or_invalid_employer_zip_postal_zone,
  "CK" => :missing_or_invalid_employer_phone_number,
  "CL" => :missing_or_invalid_employer_contact_name,
  "CM" => :missing_or_invalid_patient_street_address,
  "CN" => :missing_or_invalid_patient_city_address,
  "CO" => :missing_or_invalid_patient_state_province_address,
  "CP" => :missing_or_invalid_patient_zip_postal_zone,
  "CQ" => :missing_or_invalid_patient_phone_number,
  "CR" => :missing_or_invalid_carrier_id,
  "CW" => :missing_or_invalid_alternate_id,
  "CX" => :missing_or_invalid_patient_id_qualifier,
  "CY" => :missing_or_invalid_patient_id,
  "CZ" => :missing_or_invalid_employer_id,
  "DC" => :missing_or_invalid_dispensing_fee_submitted,
  "DN" => :missing_or_invalid_basis_of_cost_determination,
  "DQ" => :missing_or_invalid_usual_and_customary_charge,
  "DR" => :missing_or_invalid_prescriber_last_name,
  "DT" => :missing_or_invalid_unit_dose_indicator,
  "DU" => :missing_or_invalid_gross_amount_due,
  "DV" => :missing_or_invalid_other_payer_amount_paid,
  "DX" => :missing_or_invalid_patient_paid_amount_submitted,
  "DY" => :missing_or_invalid_date_of_injury,
  "DZ" => :missing_or_invalid_claim_reference_id,
  "E1" => :missing_or_invalid_product_service_id_qualifier,
  "E3" => :missing_or_invalid_incentive_amount_submitted,
  "E4" => :missing_or_invalid_reason_for_service_code,
  "E5" => :missing_or_invalid_professional_service_code,
  "E6" => :missing_or_invalid_result_of_service_code,
  "E7" => :missing_or_invalid_quantity_dispensed,
  "E8" => :missing_or_invalid_other_payer_date,
  "E9" => :missing_or_invalid_provider_id,
  "EA" => :missing_or_invalid_originally_prescribed_product_service_code,
  "EB" => :missing_or_invalid_originally_prescribed_quantity,
  "EC" => :missing_or_invalid_compound_ingredient_component_count,
  "ED" => :missing_or_invalid_compound_ingredient_quantity,
  "EE" => :missing_or_invalid_compound_ingredient_drug_cost,
  "EF" => :missing_or_invalid_compound_dosage_form_description_code,
  "EG" => :missing_or_invalid_compound_dispensing_unit_form_indicator,
  "EH" => :missing_or_invalid_compound_route_of_administration,
  "EJ" => :missing_or_invalid_originally_prescribed_product_service_id_qualifier,
  "EK" => :missing_or_invalid_scheduled_prescription_id_number,
  "EM" => :missing_or_invalid_prescription_service_reference_number_qualifier,
  "EN" => :missing_or_invalid_associated_prescription_service_reference_number,
  "EP" => :missing_or_invalid_associated_prescription_service_date,
  "ER" => :missing_or_invalid_procedure_modifier_code,
  "ET" => :missing_or_invalid_quantity_prescribed,
  "EU" => :missing_or_invalid_prior_authorization_type_code,
  "EV" => :missing_or_invalid_prior_authorization_number_submitted,
  "EW" => :missing_or_invalid_intermediary_authorization_type_id,
  "EX" => :missing_or_invalid_intermediary_authorization_id,
  "EY" => :missing_or_invalid_provider_id_qualifier,
  "EZ" => :missing_or_invalid_prescriber_id_qualifier,
  "FO" => :missing_or_invalid_plan_id,
  "GE" => :missing_or_invalid_percentage_sales_tax_amount_submitted,
  "H1" => :missing_or_invalid_measurement_time,
  "H2" => :missing_or_invalid_measurement_dimension,
  "H3" => :missing_or_invalid_measurement_unit,
  "H4" => :missing_or_invalid_measurement_value,
  "H5" => :missing_or_invalid_primary_care_provider_location_code,
  "H6" => :missing_or_invalid_dur_co_agent_id,
  "H7" => :missing_or_invalid_other_amount_claimed_submitted_count,
  "H8" => :missing_or_invalid_other_amount_claimed_submitted_qualifier,
  "H9" => :missing_or_invalid_other_amount_claimed_submitted,
  "HA" => :missing_or_invalid_flat_sales_tax_amount_submitted,
  "HB" => :missing_or_invalid_other_payer_amount_paid_count,
  "HC" => :missing_or_invalid_other_payer_amount_paid_qualifier,
  "HD" => :missing_or_invalid_dispensing_status,
  "HE" => :missing_or_invalid_percentage_sales_tax_rate_submitted,
  "HF" => :missing_or_invalid_quantity_intended_to_be_dispensed,
  "HG" => :missing_or_invalid_days_supply_intended_to_be_dispensed,
  "J9" => :missing_or_invalid_dur_co_agent_id_qualifier,
  "JE" => :missing_or_invalid_percentage_sales_tax_basis_submitted,
  "KE" => :missing_or_invalid_coupon_type,
  "M1" => :patient_not_covered_in_this_aid_category,
  "M2" => :recipient_locked_in,
  "M3" => :host_pa_mc_error,
  "M4" => :prescription_service_reference_number_time_limit_exceeded,
  "M5" => :requires_manual_claim,
  "M6" => :host_eligibility_error,
  "M7" => :host_drug_file_error,
  "M8" => :host_provider_file_error,
  "ME" => :missing_or_invalid_coupon_number,
  "MZ" => :error_overflow,
  "NE" => :missing_or_invalid_coupon_value_amount,
  "NN" => :transaction_rejected_at_switch_or_intermediary,
  "P1" => :associated_prescription_service_reference_number_not_found,
  "P2" => :clinical_information_counter_out_of_sequence,
  "P3" => :compound_ingredient_component_count_does_not_match_number_of_repetitions,
  "P4" => :coordination_of_benefits_other_payments_count_does_not_match_number_of_repetitions,
  "P5" => :coupon_expired,
  "P6" => :date_of_service_prior_to_date_of_birth,
  "P7" => :diagnosis_code_count_does_not_match_number_of_repetitions,
  "P8" => :dur_pps_code_counter_out_of_sequence,
  "P9" => :field_is_non_repeatable,
  "PA" => :pa_exhausted_not_renewable,
  "PB" => :invalid_transaction_count_for_this_transaction_code,
  "PC" => :missing_or_invalid_claim_segment,
  "PD" => :missing_or_invalid_clinical_segment,
  "PE" => :missing_or_invalid_cob_other_payments_segment,
  "PF" => :missing_or_invalid_compound_segment,
  "PG" => :missing_or_invalid_coupon_segment,
  "PH" => :missing_or_invalid_dur_pps_segment,
  "PJ" => :missing_or_invalid_insurance_segment,
  "PK" => :missing_or_invalid_patient_segment,
  "PM" => :missing_or_invalid_pharmacy_provider_segment,
  "PN" => :missing_or_invalid_prescriber_segment,
  "PP" => :missing_or_invalid_pricing_segment,
  "PR" => :missing_or_invalid_prior_authorization_segment,
  "PS" => :missing_or_invalid_transaction_header_segment,
  "PT" => :missing_or_invalid_workers_compensation_segment,
  "PV" => :non_matched_associated_prescription_service_date,
  "PW" => :non_matched_employer_id,
  "PX" => :non_matched_other_payer_id,
  "PY" => :non_matched_unit_form_route_of_administration,
  "PZ" => :non_matched_unit_of_measure_to_product_service_id,
  "R1" => :other_amount_claimed_submitted_count_does_not_match_number_of_repetitions,
  "R2" => :other_payer_reject_count_does_not_match_number_of_repetitions,
  "R3" => :procedure_modifier_code_count_does_not_match_number_of_repetitions,
  "R4" => :procedure_modifier_code_invalid_for_product_service_id,
  "R5" => :product_service_id_must_be_zero_when_product_service_id_qualifier_equals_ΓΈ6,
  "R6" => :product_service_not_appropriate_for_this_location,
  "R7" => :repeating_segment_not_allowed_in_same_transaction,
  "R8" => :syntax_error,
  "R9" => :value_in_gross_amount_due_does_not_follow_pricing_formulae,
  "RA" => :pa_reversal_out_of_order,
  "RB" => :multiple_partials_not_allowed,
  "RC" => :different_drug_entity_between_partial_completion,
  "RD" => :mismatched_cardholder_group_id_partial_to_completion,
  "RE" => :missing_or_invalid_compound_product_id_qualifier,
  "RF" => :improper_order_of_dispensing_status_code_on_partial_fill_transaction,
  "RG" => :missing_or_invalid_associated_prescription_service_reference_number_on_completion_transaction,
  "RH" => :missing_or_invalid_associated_prescription_service_date_on_completion_transaction,
  "RJ" => :associated_partial_fill_transaction_not_on_file,
  "RK" => :partial_fill_transaction_not_supported,
  "RM" => :completion_transaction_not_permitted_with_same_date_of_service_as_partial_transaction,
  "RN" => :plan_limits_exceeded_on_intended_partial_fill_values,
  "RP" => :out_of_sequence_p_reversal_on_partial_fill_transaction,
  "RS" => :missing_or_invalid_associated_prescription_service_date_on_partial_transaction,
  "RT" => :missing_or_invalid_associated_prescription_service_reference_number_on_partial_transaction,
  "RU" => :mandatory_data_elements_must_occur_before_optional_data_elements_in_a_segment,
  "SE" => :missing_or_invalid_procedure_modifier_code_count,
  "TE" => :missing_or_invalid_compound_product_id,
  "UE" => :missing_or_invalid_compound_ingredient_basis_of_cost_determination,
  "VE" => :missing_or_invalid_diagnosis_code_count,
  "WE" => :missing_or_invalid_diagnosis_code_qualifier,
  "XE" => :missing_or_invalid_clinical_information_counter,
  "ZE" => :missing_or_invalid_measurement_date,
}

Class Method Summary collapse

Class Method Details

.get_code_by_symbol(symbol) ⇒ Object



3
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5
# File 'lib/dzero/utils/rejection_codes.rb', line 3

def self.get_code_by_symbol(symbol)
  REJECTION_CODES.invert[symbol]
end

.get_symbol_by_code(code) ⇒ Object



7
8
9
# File 'lib/dzero/utils/rejection_codes.rb', line 7

def self.get_symbol_by_code(code)
  REJECTION_CODES[code]
end