Code (440-E5), Result of Service Code (441-E6), DUR Co-Agent ID Qualifier (475-J9), and DUR Co-Agent ID (476-H6) are not submitted. However in an effort to accommodate systems that are not able to suppress fields 439-E4, 440-E5, 441-E6, 475-J9, or 476-H6 on the row that communicates compound preparation effort, MassHealth will ignore if the submitted value is equal to spaces. Failure to submit this unique row will result in the claim being denied with NCPDP reject code 8E DUR/PPS Level Of Effort. –M/I MassHealth will retrospectively examine Level of Effort values entered on a compounded claim. DUR/PPS Segment Claim Billing/Claim Rebill Segment Identification = 08 Field # NCPDP Field Name Value Payer Usage Payer Situation Field Format 111-AM Segment Identification M X(2) 473-7E DUR/PPS Code Counter Maximum of nine R 9(1) occurrences DD=Drug-drug X(2) 439-E4 Reason for Service Code Q***R*** Not used with interaction Level of Effort when billing for HD=High dose preparing a compound ID=Ingredient prescription. duplication Not required when TD=Therapeutic Professional duplication Service Code ER=Early refill 440-E5 Professional Service Code MA=Medication Q***R*** Not used with X(2) administration Level of Effort when billing for M0=Prescriber preparing a consulted compound prescription. R0=Pharmacist consulted other source 441-E6 Result of Service Code 1A=Filled as is, false Q***R*** Not used with X(2) positive Level of Effort when billing for 1B=Filled preparing a prescription, as is compound prescription. 1C=Filled, with different dose Not required when 1D=Filled, with Professional Service different directions Code (440-E5)=MA 1E=Filled, with different drug 1F=Filled, with different quantity 1G=Filled, with prescriber approval Pharmacy Facts, Number 101 Page 5 of 5
Code (440-E5), Result of Service Code (441-E6), DUR Co-Agent ID Qualifier (475-J9), and DUR Co-Agent ID (476-H6) are not submitted. However in an effort to accommodate systems that are not able to suppress fields 439-E4, 440-E5, 441-E6, 475-J9, or 476-H6 on the row that communicates compound preparation effort, MassHealth will ignore if the submitted value is equal to spaces. Failure to submit this unique row will result in the claim being denied with NCPDP reject code 8E –M/I DUR/PPS Level Of Effort. MassHealth will retrospectively examine Level of Effort values entered on a compounded claim. DUR/PPS Segment Segment Identification = 08 Claim Billing/Claim Rebill Field # NCPDP Field Name Value Payer Usage Payer Situation Field Format 111-AM Segment Identification M X(2) 473-7E DUR/PPS Code Counter Maximum of nine occurrences R 9(1) 439-E4 Reason for Service Code DD=Drug-drug interaction HD=High dose ID=Ingredient duplication TD=Therapeutic duplication ER=Early refill Q***R*** Not used with Level of Effort when billing for preparing a compound prescription. Not required when Professional Service Code X(2) 440-E5 Professional Service Code MA=Medication administration M0=Prescriber consulted R0=Pharmacist consulted other source Q***R*** Not used with Level of Effort when billing for preparing a compound prescription. X(2) 441-E6 Result of Service Code 1A=Filled as is, false positive 1B=Filled prescription, as is 1C=Filled, with different dose 1D=Filled, with different directions 1E=Filled, with different drug 1F=Filled, with different quantity 1G=Filled, with prescriber approval Q***R*** Not used with Level of Effort when billing for preparing a compound prescription. Not required when Professional Service Code (440-E5)=MA X(2) Pharmacy Facts, Number 101 Page 5 of 5