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Chapter 8

TABLE 8.3 – Prescription Claim Rejection Codes

QuestionAnswer
Code 5 Missing or invalid pharmacy number
Code 6 Missing or invalid group number
Code 7 Missing or invalid cardholder ID number
Code 8 Missing or invalid person code
Code 9 Missing or invalid birth date
Code 11 Missing relationship code
Code 19 Missing days' supply
Code 22 Missing or invalid DAW (Dispense as Written) code
Code 25 Missing or invalid prescriber ID
Code 26 Missing or invalid unit of measure
Code 54 Nonmatched National Drug Code (NDC) number
Code 60 Drug not covered for patient
Code 75 Prior authorization required
Code 79 Refill too soon
22 = DAW code problem 25 = Prescriber ID problem 54 = NDC problem 60 = Drug not covered 75 = Prior authorization 79 = Refill too soon These six rejection codes (22, 25, 54, 60, 75, 79) are some of the most commonly tested on pharmacy technician exams.
Created by: Yolypooh
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