{"id":28,"date":"2011-12-22T22:38:44","date_gmt":"2011-12-22T22:38:44","guid":{"rendered":"http:\/\/www.akron.duonglam.ca\/?page_id=28"},"modified":"2011-12-22T22:43:21","modified_gmt":"2011-12-22T22:43:21","slug":"esieclips","status":"publish","type":"page","link":"https:\/\/www.akron.duonglam.ca\/?page_id=28","title":{"rendered":"ESI\/Eclips"},"content":{"rendered":"\n\n\n\n\t\n\n\t\n\t\n\t\n\t\n\t\n\t\n\t\n\t\n\t\n\t\n\t\n\t
Error Message<\/th>Intervention Code <\/th>Notes<\/th>\n<\/tr>\n<\/thead>\n
Patient has other coverage<\/td>DA<\/td>use for diabetic test strips when yearly max reached. For all other cases, please call ESI<\/td>\n<\/tr>\n
Pharmacy ID Error<\/td><\/td>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.<\/td>\n<\/tr>\n
Vacation supply<\/td><\/td>Patient must pay cash<\/td>\n<\/tr>\n
Limited use (LU) drug<\/td>MU or PC<\/td>MU-used when ODB coverage has not been ascertained. Can be used once
\nPC-unqualified for ODB coverage <\/td>\n<\/tr>\n
Child overage limit<\/td><\/td>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<\/td>\n<\/tr>\n
Duplicate drug<\/td>UG<\/td>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<\/td>\n<\/tr>\n
Step-down therapy, use first line therapy<\/td>UP - first line therapy failed
\nUQ - first line therapy not tolerated<\/td>		Step Therapy for Diabetes. contact prescriber and discuss if appropriate to change to 1st line (metformin, usually)<\/td>\n<\/tr>\n
Relationship Error<\/td><\/td>Check name is entered correctly (alias?)<\/td>\n<\/tr>\n
Alternative therapy<\/td>UP - 1st line therapy ineffective
\nUQ - 1st line therapy not tolerated<\/td>		document on hard copy why override code was used.<\/td>\n<\/tr>\n
OF-Initial Rx days supply exceeded<\/td>none<\/td>-short acting opioid limited to 7 days supply. No override available <\/td>\n<\/tr>\n
May qualify for government exception<\/td>DX-first time only
\nsee ESI Provincial Integration Program<\/td>		Must either supply copy of EAP application or letter from physician. Pt should contact insurance<\/td>\n<\/tr>\n
Patient not covered by this plan<\/td>-ensure DOB and FIRST NAME is correct
\n<\/td>		As of Oct 2019, ESI will check birth day AND patient's first name. If there is a mistake, the claim will reject<\/td>\n<\/tr>\n<\/tbody>\n<\/table>\n\n","protected":false},"excerpt":{"rendered":"","protected":false},"author":1,"featured_media":0,"parent":24,"menu_order":0,"comment_status":"open","ping_status":"open","template":"","meta":{"footnotes":""},"class_list":["post-28","page","type-page","status-publish","hentry"],"_links":{"self":[{"href":"https:\/\/www.akron.duonglam.ca\/index.php?rest_route=\/wp\/v2\/pages\/28","targetHints":{"allow":["GET"]}}],"collection":[{"href":"https:\/\/www.akron.duonglam.ca\/index.php?rest_route=\/wp\/v2\/pages"}],"about":[{"href":"https:\/\/www.akron.duonglam.ca\/index.php?rest_route=\/wp\/v2\/types\/page"}],"author":[{"embeddable":true,"href":"https:\/\/www.akron.duonglam.ca\/index.php?rest_route=\/wp\/v2\/users\/1"}],"replies":[{"embeddable":true,"href":"https:\/\/www.akron.duonglam.ca\/index.php?rest_route=%2Fwp%2Fv2%2Fcomments&post=28"}],"version-history":[{"count":4,"href":"https:\/\/www.akron.duonglam.ca\/index.php?rest_route=\/wp\/v2\/pages\/28\/revisions"}],"predecessor-version":[{"id":344,"href":"https:\/\/www.akron.duonglam.ca\/index.php?rest_route=\/wp\/v2\/pages\/28\/revisions\/344"}],"up":[{"embeddable":true,"href":"https:\/\/www.akron.duonglam.ca\/index.php?rest_route=\/wp\/v2\/pages\/24"}],"wp:attachment":[{"href":"https:\/\/www.akron.duonglam.ca\/index.php?rest_route=%2Fwp%2Fv2%2Fmedia&parent=28"}],"curies":[{"name":"wp","href":"https:\/\/api.w.org\/{rel}","templated":true}]}}