It depends a lot on what you are trying to fix.
If you can't find the right insurance plan to bill look on the card for the bin# and the PCN#. There will be a patient ID number and most times a group number. Dependent codes run like this:
Primary card holder : 1-01 every once in a while there is a company that makes you submit it at 1-00
Spouse: 2-02
Dependents (children) determined by their birth order: 3-03, 3-04, 3-05, ...
There are PA codes that will be given by the insurance when they approve an override for a refill to soon, dose change or whatever. they are submitted in the prior auth field with the prior auth type code of "1." Medicaid (at least in colorado) is different. There the PA code is always 1 and the type code changes.
There may be required "diagnosis codes" for things like diabetic supplies and other DME (durable medical equipment). You need to get the diagnosis from the prescriber and submit it to the insurance as an ICD-9 type code. For example, insulin dependent diabetes is 0250.00...
There are "submission clarification" codes as well. Most of the time, especially for medco insurances (United healthcare is a big one for them) using the number 2 will override high dose rejections and simple things like that. Vacation overrides are 3, spilled medication is 4, so on...
Then there are DUR (drug utilization review) codes as well. There are 3 fields that you need to populate according to how it is being overridden. These are the 'conflict,' 'intervention,' and 'outcome.' The most common rejections "conflict" you will get when these are necessary are High doses "HD", therapeutic duplications "TD" and drug interactions "DD". They can be approved by the prescriber "M0" the pharmacist "R0" or the patient "P0" (those second characters are zeros). and the "outcome" is usually one of these:
ØØ=Not Specified
1A=Filled As Is, False Positive
1B=Filled Prescription As Is
1C=Filled, With Different Dose
1D=Filled, With Different Directions
1E=Filled, With Different Drug
1F=Filled, With Different Quantity
1G=Filled, With Prescriber Approval
1H=Brand-to-Generic Change
1J=Rx-to-OTC Change
1K=Filled with Different Dosage Form
2A=Prescription Not Filled
So say there was a prescription for clarithromycin for a patient on simvastatin and the presciber said for them to just stop taking the simvastatin for the 10 days. You would submit it as DD M0 1G.
You will learn other tricks as well. Things like branded generics with different DAW codes get tricky and of course applying these things when you are split billing a primary insurance with a second company that uses a whole different set of codes is fun 🙂
This is the first time in my life I have felt completely ******ed! "Genome sequencing yeah, no problem" but inputting insurance is boggling my mind. Can anyone help? Or at least point me in a direction? 
