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Intervention Codes

Override codes for pharmacy claims processing

ESI Intervention Codes

Step Therapy Program

Message: PREFERRED OR STEP DRUG MUST BE SUBMITTED

• UP - First-line therapy ineffective

• UQ - First-line therapy not tolerated by patient

Telus Assure Intervention Codes

Trial for New Prescriptions

Message: INVALID DAYS SUPPLY - TRIAL DRUG PROGRAM

• MG - Trial drug program declined

Green Shield Intervention Codes

Initial Days Supply for New Prescriptions

Message: INITIAL RX DAYS SUPPLY EXCEEDED

• NH - Initial Rx program declined

Vacation Supply (max 183 days allowable)

Message: IDENTICAL CLAIM HAS BEEN PROCESSED

• MV - Vacation supply

Maintenance Medication Fill Limits (limit 5 fills/year)

Message: DAYS' SUPPLY LOWER THAN MINIMUM ALLOWABLE.

• ER - Override days' supply limit for period

Early Refill: Dose Change

Message: FILL TOO EARLY

• MN - Replacement claim due to dose change

Claim Resubmission

Message: QUANTITY REDUCTION REQUIRED

• NF - Override quantity appropriate

Audit Documentation Note

For audit purposes, the pharmacy should document all relevant details about the prescription to support the selection of the intervention code.

Frequently Asked Questions

Common questions about intervention and override codes

Pharmacy intervention codes (or override codes) are special 2-letter codes used during prescription billing to bypass specific rejections, such as early refills, vacation supplies, or step therapy requirements.

For ESI step therapy, use 'UP' if first-line therapy was ineffective, or 'UQ' if the first-line therapy was not tolerated by the patient.

To process a vacation supply through Green Shield, use the intervention code 'MV'. Be aware there is a maximum 183-day allowable supply.