pharmacies must submit the following Diagnosis Code Qualifier of “02” in

NCPDP Field 492-WE, and a qualifying Diagnosis Code in NCPDP Field 424-

DO:

(ICD-1Ø-CM) - Code indicating that the following information is a

diagnosis as defined by ICD-1Ø-CM.

In order to comply with this mandate CVS/caremark will no longer accept the

Diagnosis Code Qualifier value of ‘01’ – ICD-9.

Claim submitted with Diagnosis Code Qualifier value of ‘01’ – ICD-9 will reject

with the following or similar reject: Reject 39 <<M/I Diagnosis Code>>

than MHS, you will receive a transaction reject message when attempting to enter a prescription claim to MHS as

primary.

The transaction reject message will show the member’s current primary insurance processing information along

specialty medications, the claim will be allowed to process as long as the primary has already paid. Other

coverage codes 2, 4 and 8 are allowed for non-primary claims to process in the event the TPL has already paid or

is no longer valid.