Pharmacy 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.

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.

DOS/Date Prescribed

The number of days between Date of Service and Date Prescribed is greater than 365 days.

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.

Ineligible Pharmacy

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).

Inactive Prescriber

Prescriber was not active in NPPES on Date of Service.

Invalid Prescriber

The Prescriber was not in NPPES as an Entity Type = 1 on the Date of Service.

Not in Network

The Service Provider ID NPI on the claim is not part of the dispensed drug’s LDN.

Pre-Policy

Date of Service is before the policy start date.

Pre-Policy Claims Limit Reached

Date of Service is before the policy start date and account has reached full package limit.