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Lorazepam Order

(2011-11-24 03:04:22)
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Related article: AND The Customer Mail Order Code equals Maintenance Only Covered AND The Claim Maintenance Drug Indicator is not equal to Maintenance Drug. B B B B 70 Product/Service Not Covered 4115 B I= Default Code � Not Covered on Plan The Product/Service ID Qualifier indicates that the Product/Service ID field contains a NDC and the Plan benefit limit range table indicates a Non-Covered Drug. D D D D 70 Product/Service Not Covered 4111 B The First Date Of Service on a Claim with a Workers Compensation Customer ID is less than the date of injury on the Prior Authorization Header Table. B B B B 70 Product/Service Not Covered 4114 B If the Product/Service ID Qualifier indicates that the Product/Service ID field contains a NDC AND The NDC is a Plan Non-Covered Drug from the benefit limit range table AND No previous pricing edits have been set for this claim AND The Plan Benefit Limit Override PA is not equal to �I � (Override Initial RX). D D D D 70 Product/Service Not Covered 4121 B If the Product/Service ID Qualifier indicates that the Product/Service ID field contains a NDC AND The Claim Allowed Charge equals $0.00 AND The Group Pricing DAW code on the group pricing table equals spaces. B B B B 70 Product/Service Not Covered 4122 C If the Product/Service ID Qualifier indicates that the Product/Service ID field contains a NDC AND The drug is a Lorazepam Order Plan Non-Covered Drug AND
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