Prescription Drug Event - PDE Processing and Edit Code 792
Historically, CMS placed DDPS PDE processing on hold during the month of July for annual Part D payment reconciliation activities. This led to a significant backlog when PDE processing resumed. Beginning in 2015, to address the backlog issue, CMS only paused PDE processing for the benefit year being reconciled.
Beginning on July 1, 2021, reject edit code 792 will be returned for any PDEs with a date of service in 2020 while payment reconciliation activities are ongoing during July 2021. Notification will be distributed when edit code 792 is turned off and benefit year 2020 PDEs may be resubmitted. In order to prevent receiving this rejection, it is suggested that 2020 PDE submissions be placed on hold for the month of July. For additional information regarding this process, please refer to the April 21, 2015 HPMS memorandum titled “May 2015 Updates to the Drug Data Processing System.”
During this time period, PDEs for any benefit years other than 2020 will continue to be processed.
In the event you have questions, please contact CSSC Operations at 1-877-534-2772 (option 2) or by email at firstname.lastname@example.org.