Pharmaceutical Chargeback Reason Codes for EDI 849

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An ideal solution for pharmaceutical chargebacks
We help pharma manufacturers to maximize revenue
by ensuring that their commercial contract
management and chargeback processing are done
accurately and efficiently.
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Chargebacks DM Processing Flow
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Reject and Adjustment Reason Codes

• When a chargeback claim is incomplete or has
  errors, the manufacturer can reject the claim
  either partially, or completely.
• Rejected claim needs to be communicated back to
  wholesaler in EDI 849 chargeback reconciliation
  file with an appropriate code, explaining the
  reason for rejection and providing the adjusted
  value.

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Reason Code Categories

1. Customer
2. Product
3. Contract
4. Wholesaler
5. Pricing
6. Quantity
7. Multiple Submissions
8. Sale Date

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Customer Codes

• FF Customer not covered by the contract
• GG Customer dropped from the contract before the
  invoice date
• HH Customer was not eligible to the contract on
  the Invoice date yet
• II No Customer ID was provided
• JJ Customer ID is invalid

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Product Codes

• KK Drug is not covered by the contract
• LL Drug is not longer on the contract
• MM Drug is not on the contract yet
• NN Drug code is missing or invalid

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Contract

• AA The contract number is not supplied.
• BB Contract number supplied is not valid
• CC Invoice date is after the contract
  expiration date
• DD Invoice date is before the contract started

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Wholesaler

• OO The contract has never been loaded at the
  submitting wholesaler
• PP The wholesaler no longer carries the
  contract
• QQ The wholesaler has not been eligible for
  the contract yet

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Pricing

• SS Contract price was not supplied
• TT Contract price was not correct
• UU Wholesaler acquisition cost was missing
• VV Wholesaler acquisition cost was incorrect
• WW Extended chargeback amount not provided
• XX Extended chargeback amount incorrect

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Quantity

• A1 Insufficient Wholesaler Inventory
• A3 Quantity Invalid - Free Goods
• A5 Minimum Order Quantity Not Met
• RR Quantity Invalid or Not Supplied

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Multiple Submissions and Sale Date

• A4 Rebill Without Offsetting Credit
• RI Invalid Resubmit Number
• YY Duplicate Chargeback Request
• A2 Line Item Too Old
• EE Invoice Date Missing or Invalid

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