Beacon uses validation codes to identify and communicate back-end errors at the claim-line level. These codes help explain why a claim may not meet certain requirements after successful transmission of 340B claims data through Beacon’s web application or SDK.
Use the table below to understand the back-end validations applied to medical claim submissions. Each validation code includes a description of the issue detected and, where applicable, guidance for resolution.
Tip: Interested in learning more about validations performed before submitting data to Beacon, check out Front-end Validations.
Medical Claims Validation Code Glossary
Validation Code | Description |
Aberrant Quantity | Quantity is out of range of expected quantity and/or not a multiple of an expected quantity. View Beacon’s NDC list available for download here to learn more. |
Invalid Unit of Measure | The HCPCS code or the Unit of Measure could not be associated to the NDC-11. |
ACA Orphan Drug | The NDC-11 is an orphan drug and 340B pricing is not available for the covered entity type. |
NDC Expired | NDC was expired on Date of Service. |
Claim Expired | Date of Service is more than 45 days from the claim’s submission date to Beacon. |
Duplicate | Claim is either duplicative of a previous submission by the same entity or a previous submission by a different entity. |
Entity Type Invalid | Entity is not in scope of the policy. |
Ineligible Covered Entity | The covered entity was not enrolled in the 340B program on the Date of Service. |
Inactive Prescriber | Prescriber NPI was not active in NPPES on the Date of Service. |
Invalid Prescriber | The Prescriber NPI was not in NPPES as an Entity Type = 1 on Date of Service. |
Ineligible Administration Site |
The Service Provider ID NPI meets one of the following conditions as of the Date of Service: 1) missing or inactive within the NCPDP and NPPES databases, 2) not a covered entity site, shipping address, or contract pharmacy according to HRSA OPA enrollment data, or 3) not eligible to dispense 340B-priced drugs according to the manufacturer’s contract pharmacy policy (i.e., a contract pharmacy not designated within 340B ESP).
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Pre-Policy | Date of Service is before policy start date. |
Pre-Policy Claims Limit Reached | Date of Service is before policy start date and account has reached full package limit. |
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