Pharmacy Encounter Claims
Use this article to understand the post-submission validations that may appear after submitting Pharmacy Encounter claims in 340B ESP and what they mean for your submission.
Post-submission validations may appear as either Issues or Warnings depending on the applicable manufacturer policy. The same validation may be treated as an Issue for one manufacturer, a Warning for another, or may not apply.
A single claim may also be associated with more than one Issue or Warning. As a result, validation counts may not add up to the total number of processed claims.
List of Pharmacy Encounter Submission Issues & Warnings
Validation | What it means |
Claim Expired | Date of dispense is outside the manufacturer's lookback period. |
Invalid Service Provider ID | Provider ID cannot be linked to an in-house pharmacy or contract pharmacy for the 340B ID. |
Aberrant Quantity | The quantity submitted for the claim falls outside the expected range for the applicable product. |
Duplicate | Identified as duplicative of a previously submitted claim. |
Duplicate - Submission Type | The claim was identified as a duplicate of a claim previously submitted under another submission type. |
Invalid Prescriber ID | The ID provided could not be verified as a valid prescriber in the registry. |
Missing Prescriber ID | No value was provided for this field in the submitted claim. |
Missing Payer BIN | No value was provided for this field in the submitted claim. |
Missing Payer PCN | No value was provided for this field in the submitted claim. |
Invalid Encounter Billing Service Provider ID | The ID provided could not be verified as valid for the encounter billing service provider. |
Missing Encounter Billing Service Provider ID | No value was provided for this field in the submitted claim. |
Missing Encounter Date of Service | No value was provided for this field in the submitted claim. |
Invalid Encounter Rendering Physician ID | The ID provided could not be verified as valid for the encounter rendering physician. |
Missing Encounter Rendering Physician ID | No value was provided for this field in the submitted claim. |
Invalid Encounter Place of Service Code | The Encounter Place of Service Code provided does not meet the applicable validation requirements. |
Missing Encounter Place of Service Code | No value was provided for this field in the submitted claim. |
Missing Encounter HCPCS Code | No value was provided for this field in the submitted claim. |
Invalid Encounter HCPCS Code | The Encounter HCPCS Code provided does not meet the applicable validation requirements. |
Invalid Encounter HCPCS Code Modifier 1 | Encounter HCPCS Code Modifier 1 does not meet the applicable validation requirements. |
Invalid Encounter HCPCS Code Modifier 2 | Encounter HCPCS Code Modifier 2 does not meet the applicable validation requirements. |
Invalid Encounter HCPCS Code Modifier 3 | Encounter HCPCS Code Modifier 3 does not meet the applicable validation requirements. |
Invalid Encounter HCPCS Code Modifier 4 | Encounter HCPCS Code Modifier 4 does not meet the applicable validation requirements. |
Missing Encounter Diagnosis Code Primary | No value was provided for this field in the submitted claim. |
Invalid Encounter Diagnosis Code Primary | The Primary Encounter Diagnosis Code provided does not meet the applicable validation requirements. |
Invalid Encounter Diagnosis Code 2 | Encounter Diagnosis Code 2 does not meet the applicable validation requirements. |
Invalid Encounter Diagnosis Code 3 | Encounter Diagnosis Code 3 does not meet the applicable validation requirements. |
Invalid Encounter Diagnosis Code 4 | Encounter Diagnosis Code 4 does not meet the applicable validation requirements. |
Invalid Encounter Diagnosis Code 5 | Encounter Diagnosis Code 5 does not meet the applicable validation requirements. |
Invalid Encounter Diagnosis Code 6 | Encounter Diagnosis Code 6 does not meet the applicable validation requirements. |
Invalid Encounter Diagnosis Code 7 | Encounter Diagnosis Code 7 does not meet the applicable validation requirements. |
Invalid Encounter Diagnosis Code 8 | Encounter Diagnosis Code 8 does not meet the applicable validation requirements. |
Invalid Encounter Diagnosis Code 9 | Encounter Diagnosis Code 9 does not meet the applicable validation requirements. |
Invalid Encounter Diagnosis Code 10 | Encounter Diagnosis Code 10 does not meet the applicable validation requirements. |
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