| Discrepancy Type |
Recovery Amount |
Documentation Required to Contest |
| Exceeds Plan Limits |
Net Amount Paid |
Not Addressable |
| Incorrect Days Supply Submitted |
Net Amount Paid |
Not Addressable |
| DAW-1 Error (Generic/Less Expensive Product Should Be Billed) |
Net Amount Paid |
Not Addressable |
| Other Incorrect DAW/product select code (PSC) Submitted |
Net Amount Paid |
Not Addressable |
| Dispensed Less Than Prescribed (Cut Quantity) |
Net Amount Paid |
Not Addressable |
| Dispensed Greater Than Prescribed |
Net Amount Paid |
Not Addressable |
| Incorrect Drug Billed (NDC Discrepancies) |
Net Amount Paid |
Not Addressable |
| Missing Prescription Documentation |
Net Amount Paid |
Not Addressable |
| Missing Signature Log |
Net Amount Paid |
Patient Statement |
| Patient Contests Receipt |
Net Amount Paid |
Patient Statement |
| Patient Name Different |
Net Amount Paid |
Not Addressable |
| Invalid Prescriber ID |
Net Amount Paid |
Covering Original Prescription or Physician Statement |
| Prescriber Cannot Be Identified |
Net Amount Paid |
Covering Original Prescription or Physician Statement |
| Prescriber Contests Authorizing Prescription |
Net Amount Paid |
Covering Original Prescription or Physician Statement |
| Prescription Not on File |
Net Amount Paid |
Covering Original Prescription or Physician Statement |
| Unauthorized Refill |
Net Amount Paid |
Covering Original Prescription or Physician Statement |
| Refill Too Soon |
Net Amount Paid |
Not Addressable |
| No Record of Refill |
Net Amount Paid |
Not Addressable |