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PRO REVIEW HASHTAGS

Across
prescriber <MDTitle> <MDName> per sig comp w/ rx# <RxNumb> dctech<site>
resp rcvd, ncopy performed to change locked fields dctech59
Quantity consolidated to max allowed by plan / Refills Adjusted dctech<site>
For insurance billing purposes, is the qty indicated on the Rx a 90 day supply? (__)YES (__)NO. If not a 90 day supply, indicate day supply here: _________. Sign, date, and return this form. Thank you
fax clarification response for approval to fill 90 day supply received dctech<site>
This is a courtesy call to inform you that a provider's license is inactive. State regulations allow one final 90 day fill in this situation. Impacted prescriptions have been processed accordingly. You will need a new prescription next time. If you have any questions, please call the number on the back of your card and ask to speak to a pharmacist
A refill transfer from another pharmacy has been faxed over to Express Scripts. If this medication is OK to fill for a 90 day supply, please PROVIDE the DIRECTIONS, QUANTITY, and REFILLS sign and return
clar fax rcvd sigst verified dctech<site>
Down
cqwan fax sent ftdc<site>
Do not fax, please call the patient and get current md info. Need name, address, phone, fax if available
We could not determine the name of the prescriber. Please clearly print his/her full name, DEA #, NPI # and license # and return this form.
Your patients plan will allow us to fill for a 90 day supply but we cannot calculate the appropriate amount needed based the information provided. Please review and indicate the specific quantity needed for a 90 day supply, sign and return
Mid-Level Practitioner cannot dispense more than <amount> amount of control substances, ask for the prescriber to be changed to a physician's name in order for patient to receive full quantity prescribed. If office unwilling to provide doctor name, ask for supe MD name and let office now the QTY will be cut.
Quantity consolidated to max allowed by plan / Refills Adjusted. Prescriber notified via fax dctech<site>
license is inactive. State regulations allow one final 30 day fill in this situation. Please call us back at 800-934-1296. If you do not respond within 48 hours the impacted rx(s) will be processed for 30 day supply
do not fax, please call for valid NPI/DEA ftdc<site>
clar fax rcvd sigel verified dctech<site>
clar fax rcvd mdsig verified dctech<site>