| Error Message | Intervention Code | Notes |
|---|---|---|
| Patient has other coverage | DA | use for diabetic test strips when yearly max reached. For all other cases, please call ESI |
| Pharmacy ID Error | this error will occur if there has been 5 error messages in a row. you will need to contact ESI help desk to have them reset their system to clear this message. | |
| Vacation supply | Patient must pay cash | |
| Limited use (LU) drug | MU or PC | MU-used when ODB coverage has not been ascertained. Can be used once PC-unqualified for ODB coverage |
| Child overage limit | if child is not overage, ie <18, this may mean the plan has been terminated. Call ESI to see if there is a new card on file | |
| Duplicate drug | UG | check to ensure adequate number of days have passed for refill. For smart cards, 3 days need to pass before 2nd claim can be processed. Use intervention code DA and MV |
| Step-down therapy, use first line therapy | UP - first line therapy failed UQ - first line therapy not tolerated | Step Therapy for Diabetes. contact prescriber and discuss if appropriate to change to 1st line (metformin, usually) |
| Relationship Error | Check name is entered correctly (alias?) | |
| Alternative therapy | UP - 1st line therapy ineffective UQ - 1st line therapy not tolerated | document on hard copy why override code was used. |
| OF-Initial Rx days supply exceeded | none | -short acting opioid limited to 7 days supply. No override available |
| May qualify for government exception | DX-first time only see ESI Provincial Integration Program | Must either supply copy of EAP application or letter from physician. Pt should contact insurance |
| Patient not covered by this plan | -ensure DOB and FIRST NAME is correct | As of Oct 2019, ESI will check birth day AND patient's first name. If there is a mistake, the claim will reject |
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