CMS Pub. 100-04, ch. 17, § 100.2.3.1

Prescription order numbers submitted with inappropriate spaces inserted disrupt the

matching process between the physician/provider claims and the vendor claims.

Effective for claims processed on or after July 7, 2008, contractors shall implement edits

to treat these claims as unprocessable.

Prescription order numbers submitted with less than 10 characters on CAP claims will

also be treated as unprocessable. For either of the two prior situations, the contractor

shall use the following remittance advice messages and associated codes when

rejecting/denying claims under this policy. This CARC/RARC combination is compliant

with CAQH CORE Business Scenario Two.

Group Code: CO

CARC: 16

RARC: N388

MSN: N/A

In addition, CAP physicians/providers and CAP vendors may not submit new claims

(processed as entry code 1) with prescription order numbers that they have already

submitted on previously adjudicated claims, even if the prior claims have been denied.

The CAP physicians/providers and CAP vendors must request an adjustment to the

original claim (processed as entry code 5). Claims that have been returned as

unprocessable may be accepted with the original prescription order number when

resubmitted after being corrected.

CWF will create a new utilization error code that will be returned when it receives a

claim that has a prescription order number on it that matches a prescription order number

already on file from a different claim. This claim could be from the same

physician/provider/supplier or a different physician/provider/supplier. CWF coding will

differentiate between claims from the physicians/providers and claims from the CAP

vendors. It will be acceptable to allow a claim with a duplicate prescription order number

as long as one claim is from a physician/provider and the other claim is from the vendor.

This will allow the prescription order number matching process to continue.

Contractors shall treat as unprocessable the entire claim when a claim receives the new

CWF utilization error code. Contractors shall not allow appeals rights on claims treated

as unprocessable in response to the new error code.

The contractor shall use the following remittance advice messages and associated codes

when rejecting/denying claims under this policy. This CARC/RARC combination is

compliant with CAQH CORE Business Scenario Two.

Group Code: CO

CARC: 18

RARC: N389, M16 and N185

MSN: N/A