Transaction Codes Glossary

Code

Description

Type

Definition

001

Original Claim

Transaction

First MFP-eligible claim transmitted to a Primary Manufacturer for a given dispense.

002

Adjustment Claim

Transaction

Adjustment of a previously transmitted MFP-eligible claim. If the MTF receives a claim for a MFP-eligible claim that was previously reversed, then the MTF will use this transaction code.

003

Reversal Claim

Transaction

Reversal of a previously transmitted MFP-eligible claim.

004

Informational Claim

Transaction

Adjustment of a previous transmitted MFP-eligible claim where there were changes to data points that did not change the standard default refund amount.

005

Withdrawal Notice

Transaction

The MTF is notifying the Primary Manufacturers that the MTF PM is going to make a withdrawal based on previously submitted MRAs.

009

Claim is not MFP-eligible

Transaction

The claim is not currently MFP-eligible, such as a unresolved DDPS edit or other situation.

011

Coordinate with Plan (Original Claim)

Transaction

Original MFP claim that does not require direct dispensing entity reimbursement, such as direct member reimbursement (DMR) claims, Medicaid subrogation claims, etc. The manufacturer should coordinate reimbursement with the Plan outside the MTF.

012

Coordinate with Plan (Adjustment Claim)

Transaction

Adjustment MFP claim that does not require direct dispensing entity reimbursement, such as direct member reimbursement (DMR) claims, Medicaid subrogation claims, etc. The manufacturer should coordinate reimbursement with the plan outside the MTF.

013

Coordinate with Plan (Reversal Claim)

Transaction

Reversal MFP claim that does not require direct dispensing entity reimbursement, such as direct member reimbursement (DMR) claims, Medicaid subrogation claims, etc. The manufacturer should coordinate reimbursement with the plan outside the MTF.

021

Original Claim for Unenrolled Dispensing Entity

Transaction

Original MFP-eligible claim for a dispensing entity that is not enrolled into the MTF. There may be a delay in payment withdrawal until the dispensing entity completes enrollment. When the dispensing entity completed enrollment after an MRA receipt, transaction code 005 will be used to signify a withdrawal notice.

022

Adjustment Claim for Unenrolled Dispensing Entity

Transaction

Adjustment MFP-eligible claim for a dispensing entity that is not enrolled into the MTF. There may be a delay in payment withdrawal until the dispensing entity completes enrollment. When the dispensing entity completed enrollment after an MRA receipt, transaction code 005 will be used to signify a withdrawal notice.

023

Reversal Claim for Unenrolled Dispensing Entity

Transaction

Reversal MFP-eligible claim for a dispensing entity that is not enrolled into the MTF. There may be a delay in payment withdrawal until the dispensing entity completes enrollment. When the dispensing entity completed enrollment after an MRA receipt, transaction code 005 will be used to signify a withdrawal notice.

090

Invalid MRA Response

Transaction

The MRA transaction contained an error sent by the manufacturer. At least one MRA error code will be populated by MTF.

092

Manufacturer-Initiated Adjustment Receipt

Transaction

After the MTF DM system receives an accepted manufacturer-initiated adjustment, the MTF DM will transmit the new ICN to the manufacturer and confirm receipt of the manufacturer-initiated adjustment.

099

No claims for the selected drug of the primary manufacturer.

Transaction

Indicates there are no claims for the drug for a given MTF processing day. No other transaction codes will be transmitted