Why did my file fail with an “invalid product code” error?
Product is sometimes misinterpreted as the type of business you, as the payer, see yourself doing. Actually, the value in the product field (ME003,MC003,DC003,PC003) should reflect the type of product that a subscriber/member is covered under instead of what type of insurance company the payer considers itself. There were many payers using the code of CI – Commercial for every member to say that they are a commercial insurer, yet the members were covered by products that would be considered a POS product (‘PS’ in the eligibility file or ’13’ in the medical, dental, or prescription claims files) or PPO product (‘PR’ in the eligibility file or ’12’ in the medical, dental, or prescription claims files) or IND product (‘IN’ in the eligibility file or ’15’ in the medical, dental, or prescription claims files). In an attempt to clarify this situation and avoid confusion over what we are looking for in this field, Rule 243 was modified and some commonly misused products codes were eliminated.
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