← Glossary · Medicare Advantage & Part D
Rejected claim
A pharmacy drug claim the plan did not pay, reported with its reject reason codes and pharmacy messages. Tables 1 and 2 list these.
FA Tables 1 and 2 include every rejected claim with a date of service in the review period. Each record shows the date of fill, the date of rejection, and every reject reason code with its pharmacy messaging. In the impact analysis, CMS also looks for a later paid claim for the same drug or a related drug, and at how many days the enrollee went without medication.
Source: FA protocol, Tables 1 & 2 guidance and layout, PDF pp. 10-13; Table 2IA, PDF pp. 21-26.