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    TPA Drug Manufacturer
    Will the new Dispute Management functionality check submissions when the D14 Reason Code is used?

    Although format and content edits will be performed for most Reason Codes, the Dispute Management functionality check cannot be run on Reason Code D14. This Reason Code is defined as “Total accumulated gap discounts reported across multiple PDEs for a single beneficiary exceed cumulative maximum discount amount.” Additional historic information, required to perform a functionality check, is not available on the Dispute Management system at the time the Dispute is uploaded. Please refer to the HPMS guidance document on Maximum Applicable Discounts for further information dated January 27, 2012 and memo update dated March 4, 2014.


    last updated on 05/02/2016