After claims are submitted, 340B ESP performs post-submission validations against applicable data and manufacturer requirements. These validations determine whether each processed claim is Conforming or Non-Conforming and may identify Issues or Warnings for additional review.
Conforming and Non-Conforming Claims
Each processed claim receives a validation outcome after post-submission validation is complete.
Conforming – The claim meets the validation requirements enforced under the applicable manufacturer policy.
Non-Conforming – The claim fails one or more validation requirements enforced under the applicable manufacturer policy.
A claim may be evaluated against multiple validation requirements before its final outcome is determined.
Issues and Warnings
Post-submission validation results may appear as either an Issue or a Warning.
Issues – Identifies a validation requirement that is enforced under the applicable manufacturer policy. When a claim fails a validation classified as an Issue, the claim is considered Non-Conforming.
Warnings – Identifies a validation concern that does not currently cause the claim to be considered Non-Conforming under the applicable manufacturer policy. A claim with one or more Warnings may still be Conforming. Review the identified Warnings to determine whether the submitted data may need to be corrected or updated for future submissions.
The same validation may be treated as an Issue for one manufacturer, a Warning for another, or may not apply at all. Always review the applicable manufacturer policy to understand how a validation affects a claim.
A single claim may also have more than one Issue or Warning. As a result, Issue and Warning counts may not equal the total number of claims, and percentages shown for individual validation types are not cumulative.
Learn: For a list of post-submission validations, including definitions and guidance for specific Issues and Warnings, see the applicable article:
Post-Submisison Issues and Warning Codes.
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