Effective April 17, 2018, the ICD-10 diagnosis code will be required when you receive a prompt at the point-of-sale (POS) requiring you to verify diagnosis information for UnitedHealthcare Community Plan of Virginia members who are filling prescriptions for HIV medications. This requirement will check that the diagnosis matches the FDA-approved use or a use supported by the current published evidence.
If a diagnosis is missing in the POS system, you will receive the message:
NCPDP Reject Code 39 – "Missing Invalid Diagnosis code"
If the diagnosis is in the POS system, but not a match for the National Drug Code (NDC) on the submitted claim, or if you do not submit a diagnosis on the claim, you will receive the message:
NCPDP Reject Code 80 – "Submitted Dx excluded for product"
If a valid diagnosis is not available, please ask the prescriber and/or member to request prior authorization.
*Please see attached for more information*