Response Codes

This topic is intended for Independent pharmacies only and is not applicable to Rexall pharmacies.

There are four different response codes that can be returned in a CRO edit. Use the dropdowns below to learn how to resolve each issue and prevent these codes from reappearing on future claims.

To manually override an edit before it appears in Propel Rx, enter a "*" in the Special Auth # field for the first online Third Party in the Third Party tab before filling.

The amount you are billing to a private Third Party is lower than the current McKesson list price.

To address a Cost-to-Operator Pricing Edit:

  1. Verify the drug cost with your supplier.

  2. In Rx Detail, select the expander button in the Price section. The Pricing Details window opens.

  3. Select the Price Override checkbox.

  4. Update the Cost Before Markup and Markup to reflect the suggestion.

  5. Select OK.

  6. Fill the prescription.

  7. Open the Drug Folder. In the Inventory tab, update the drug price to prevent future edits.

The Quantity edit helps protect your profits by validating the submitted cost of the prescription against the expected total cost for the pack size being dispensed. This edit appears for government and private Third Party plans.

To address a Quantity edit:

  1. In Rx Detail, confirm the correct quantity has been entered in the Qty field.

  2. Select the folder button in the Drug section to open the Drug Folder.

  3. Select the main tab of the Drug Folder.

  4. Select TP Rules. The Drug Third Party Rules window opens.

  5. Confirm the correct quantity is entered in the TP Qty field.

  6. Select OK to return to the Drug Folder.

  7. Select OK to return to Rx Detail.

  8. Fill the prescription.

The price you are billing is lower than the current provincial formulary price.

To address a Government Formulary Pricing Edit:

  1. Verify the drug cost on your provincial formulary.

  2. In Rx Detail, select the expander button in the Price section. The Pricing Details window opens.

  3. Select the Price Override checkbox.

  4. Update the Cost Before Markup and Markup to reflect the suggestion.

  5. Select OK.

  6. Fill the prescription.

  7. Open the Drug Folder. In the Main tab, update the price in the Prov $ field to prevent future edits.

The claim may be eligible for a MI intervention code, based on the recent claim history. This edit only appears for ODB claims in Ontario.

To address a Replacement Cost Pricing Edit:

  1. In the Rx Detail Third Party tab, select Add.

  2. Search for and select the MI intervention code.

  3. Fill the prescription.