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Can someone explain to me the MedSync submission clarification codes 47 and 48?

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justjoe

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47
Shortened Days Supply Fill
-
only used to request an override to plan limitations when a shortened days supply is being
dispensed.


Does this code override a refill too soon rejection when doing a short fill? But can't you just sync their meds based on when they will be out? Is this code more for if the patient has been taking their medication wrong and has fewer tablets than they should? Or possibly, the patient doesn't care if one of their meds always has a greater amount of tablets than the other? They just want everything filled on the same day?

48
-
Fill Subsequent to a Shortened Days Supply Fill
-
only used to request an override to plan limitations when a fill
subsequent to a shortened days supply is being dispensed.

So, if you have to short fill it again before insurance will pay for it normally, you use this one?

Do these codes affect the patient's copay?

Thanks!
 

zelman

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These codes don't seem to be to override "refill too soon". They seem to be for overriding things like "MAX 30 TABLETS IN 30 DAYS". If you gave them 15 tablets 15 days ago and now they need the full 30 days, it will hit a plan limitation as that would be 45 tablets in a 30 day window. Code 48 should override this.
 
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