Submission Clarification Codes
Transmission fields NX-354 and DK-420 contain the Submission Clarification Code Count and Submission Clarification Codes, respectively. NX-354 contains the number of Submission Clarification Codes attached to a single claim, and DK-420 (which can be stacked multiple times) contains each separate code. The field is always 2-digits and can be attached to a claim by entering /XDxx (where xx = the code number) into the SIG lines.
Insurances use Submission Clarification Codes as a form of override, typically on claims that need to be filled early, have a larger than usual supply, or have been misplaced and need to be replaced. Below are commonly used clarification codes.
|08||Process Compound for Approved Ingredients|
Insurances will also use this field for other, less common overrides.
When an insurance is uncertain about a doctor's new NPI, they may require a /XD42 or /XD43 to override a reject: Missing/Invalid DOC NPI. Please verify the NPI before submitting this override, as you can be subject to insurance audit if you submit an invalid NPI.
Certain Insurances also require a /XD08 for compound claims.