Submission Clarification Codes

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Transmission fields NX-354 and DK-420 contain the Submission Clarification Code Count and Submission Clarification Codes, respectively. NX-354 contains the number of Submission Clarification Codes attached to a single claim, and DK-420 (which can be stacked multiple times) contains each separate code. The field is always 2-digits and can be attached to a claim by entering /XDxx (where xx = the code number) into the SIG lines.

Insurances use Submission Clarification Codes as a form of override, typically on claims that need to be filled early, have a larger than usual supply, or have been misplaced and need to be replaced. Below are commonly used clarification codes.

Code Description
00 Not Specified
01 No Override
02 Other Override
03 Vacation Supply
04 Lost Prescription
05 Therapy Change
06 Starter Dose
07 Medically Necessary
08 Process Compound for Approved Ingredients
09 Encounters
99 Other

Insurances will also use this field for other, less common overrides.
When an insurance is uncertain about a doctor's new NPI, they may require a /XD42 or /XD43 to override a reject: Missing/Invalid DOC NPI. Please verify the NPI before submitting this override, as you can be subject to insurance audit if you submit an invalid NPI.

Certain Insurances also require a /XD08 for compound claims.