ODB Intervention Codes

The use of any Intervention Code is based on the professional judgement of the pharmacist. Proper documentation to support the use of the Intervention Code should always be maintained.

Message: Prescriber ID error
MH - override prescriber ID

Generic drug not available - dispensing brand name
MI - No interchangeable available at less than or equal to Drug Benefit Price plus allowable mark-up

Message: Maximum cost is exceeded
MO - valid claim value $500 to $999.99
MP - valid claim value $1,000 to $9,999.99

Message: Identical claim processed (Vacation Supply)
MV - vacation supply

Message: Drug/drug interaction potential
UA - consulted prescriber and filled Rx as written
UF - patient gave adequate explanation. Rx filled as written
UG - cautioned patient. Rx filled as written
UI - consulted other source. Rx filled as written

Message: Initial Rx Days’ Supply Exceeded
NH - Initial Rx Program Declined

Message: Quantity Reduction Required
NF - Override - Quantity Appropriate

Message: Patient first name error or Patient last name error
PB - name entered is consistent with card

Message: Exceeds max. # of prof. fees for this drug
UN - Assessed patient. Therapy is appropriate

Message: No Private Insurance Attestation Missing
U - Enter Special Service Code “U” if submitting a claim for a child/youth 24 years of age and under who does not have a private plan

Medically Necessary ODB No Sub Claims

Product Selection: Enter reason code “1” to indicate prescriber-directed medically necessary “No Substitution”
Medical Condition/Reason for Use: Enter “901” to indicate that a Side Effect Reporting Form has been completed and signed by the prescriber