Intervention "C" codes, Refusal to Fill Table 2
FHIR: Claim.supportingInfo:Reason.reason.coding.code
Status: DRAFT
Definition: Indicates the reason why a dispense was not performed. This may be conveyed as a reason code to support a Professional Services claim.
CPHA3: These are currently on the Intervention Code List,sent today as interventions, along with a SSC** (eg 1 - Refuse to Fill).
Refuse to Fill Codes
| CPHA Code | Description | FHIR Refuse to Fill |
|---|---|---|
| CA | Prior Adverse Reaction | |
| CB | Previous Treatment Failure | |
| CD | Therapeutic Duplication | |
| CF | Falsified or Altered Prescription | |
| CH | Dangerously High Dosage | |
| CI | Significant Drug Interaction | |
| CL | Sub-therapeutic Dose | |
| CM | Suspected Multi-pharmacy/Multi doctor | |
| CO | Potential Overuse/Abuse |
CPH3A Spec, Table 2 Definition
DUR intervention procedures taken or identify that special coverage and payment rules are being claimed
Table 2 contains INTERVENTION & EXCEPTION CODES which the provider (pharmacy) uses to communicate various cautionary concerns to the processor.
These Codes and Code Values are included in Field D.65.03, Intervention Codes. Other Codes and Code Values can be assigned by CPhA upon the request of a provider,
processor or payor. Providers may communicate the messages represented by these codes as a part of the initial submission or in response to requests or rejections by the processor
** These are typically used for Refusal to Fill situations in BC**
APPENDIX 3 PHARMACEUTICAL SERVICE and CAUTION CODE TABLES
(updated March 2011)
There has been an increasing interest, by both the providers and purchasers of pharmaceutical products and services, to communicate information with respect to drug utilization review, pharmacist interventions and enhaced treatment outcomes. This Appendix has been prepared to serve as a guideline to the use of the Pharmacy Claim Standard. The objectives are:
- to draw attention to potential treatment problems which are detected by reference to the claim processor's history and information data base
- to communicate potential problems identified by provider's observations with respect to the prescription, patient compliance or drug utilization and to report interventions to enhance therapeutic outcomes, prevent adverse effect and misuse and to promote appropriate use
- to identify special services supplied by the provider
- to report the result, or outcome, of interventions made by the provider
- to indicate the level of service for which the provider is to be compensated.|
The following discussion is intended to achieve uniformity in the interpretation of the purpose of this Appendix and the use of the individual tables it contains.