G. Diagnosis Code File

G. Diagnosis Code File


Diagnosis codes enable pharmacies to successfully submit insurance claims that require clinical context.

Common Scenarios

  • Claim rejects for missing or invalid diagnosis code

  • Claim rejects for drug–diagnosis mismatch

  • Payer requires ICD-10 code for coverage approval (e.g., Medi-Cal)

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Diagnosis Code File

Diagnosis codes (commonly ICD-10 codes) are clinical values used during prescription processing and insurance claim submission. In BestRx, diagnosis codes can:

  • Be entered manually on the Rx Processing screen

  • Be added to the Diagnosis Code File if not already available

Diagnosis codes are often required when:

  • A payer needs clinical justification for a medication

  • A claim rejects due to:

    • Missing diagnosis code

    • Invalid diagnosis code

    • Drug–diagnosis mismatch

To access the Diagnosis File screen, click on File G. Diagnosis Code File.

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Adding a New Diagnosis Code

Select Add New Diagnosis Code, enter the Diagnosis Code and Description, then click Save to save the record or Save & Exit to save the record and return to the Rx Processing screen.

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Editing an Existing Diagnosis Code

Select Edit Diagnosis Code and search for a record by entering all or part of the diagnosis code or description. You can also use the search buttons to browse all diagnosis codes. Select a record by clicking its row or entering the line number, make the necessary changes, then click Save or Save & Exit.

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Deleting a Diagnosis Code

Select Edit Diagnosis Code, locate the diagnosis code, and click Delete. When prompted, click Yes to confirm the deletion.

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Click Cancel, or press Enter while the Cancel button is highlighted, to clear all information currently displayed on the screen.


Diagnosis Codes in Rx Processing

Diagnosis codes are entered directly from the Rx Processing screen. The Diagnosis Code field is located near the bottom center of the screen. To access diagnosis code lookup, select More next to the Diagnosis Code field.

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When the Diagnosis Code window opens, select the magnifying glass icon to search for an existing diagnosis code or a code that was previously created in the Diagnosis Code File. Select the appropriate diagnosis code and click Save.

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The selected diagnosis code will automatically populate the Diagnosis Code field in Rx Processing.

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