DocStation DUR/PPS Overrides Guide
This article explains the claim edit overrides supported in DocStationâs BIN billing. It covers what each override does, when to use it, and the exact DUR/PPS codes to enter.
Quick glossary
Claim edit: A validation that blocks or warns on submission based on payer and policy rules.
DUR/PPS override: Three fields entered in the claim to proceed when policy allows.
Intermediary authorization override: A separate set of fields for certain workflows.
Supported Overrides
Not Typically Covered by Medicare Part B
When it appears: Vaccine billed to Medicare payer PCN when Medicare typically does not cover it under Part B.
What to do: Enter DUR codes PP, 00, 1B.
Result: Claim proceeds per configured logic if otherwise valid.
Eligibility Check Override
Options:
Intermediary authorization override: Enter OEC in the intermediary authorization fields.
DUR/PPS alternative: Enter DUR codes TP, R0, 1B.
Result: Skips eligibility check and proceeds if otherwise valid.
Reverse Claim Override (PMS Reversal Enablement)
Scenario: User wants to reverse in their PMS and rebill to the PBM while retaining the medical claim on DocStation. This does not change the medical claim in DocStation.
What to do: Enter DUR codes PP, 00, 1B.
Result: Enables reversal in the PMS only. No action is taken on the DocStation medical claim.
Diagnosis Code Required
When it appears: Nonâvaccine mapped HCPCS submitted without a diagnosis code in Clinical Segment Field 404âDO.
What to do: Add the diagnosis code. This is a hard stop with no override when enabled.
Result: Claim submits once a valid diagnosis code is provided.
Refill Too Soon
When it appears: Attempting to refill 7 or more days before the previous span end date.
What to do: Enter DUR codes ER, 00, 1B.
Result: Claim proceeds with a paid response if otherwise valid.
Prior Authorization (PA) Required
When it appears: Claim includes specific mapped HCPCS that require PA.
What to do: If PA is on file, enter DUR codes PA, M0, 1B.
Result: Claim proceeds with a paid response if otherwise valid.
How to enter DUR/PPS overrides in DocStation
Open the claim that shows the edit message.
Locate the DUR/PPS segment fields in the claim form.
Enter the three code values in order. Example for âRefill too soonâ: ER, 00, 1B.
Resubmit the claim.
Confirm the response. If the claim still rejects, review the edit message for additional requirements.
Tip: For teams already fluent with intermediary authorization overrides, OEC remains available for eligibility bypass. The DUR option is provided for ease of use.
FAQs
Why do I see a hard stop for diagnosis code?
For certain nonâvaccine HCPCS, a diagnosis is required for compliance. Add the diagnosis in Field 404âDO and resubmit. No override is available for this edit when enabled.
Will the Reverse Claim override cancel my DocStation medical claim?
No. It only allows reversal in your PMS and does not change the DocStation medical claim status.
Do I need to enable these edits somewhere?
Claim edits can be toggled in the RelayHealth integration configuration. Check with your admin or Support via chat if you are unsure which edits are enabled for your site.
Troubleshooting
The override did not work
Confirm you are overriding the correct edit with the matching codes.
Verify any additional information in the rejection message.
I cannot find the DUR/PPS segment
Ensure you are editing the claim in the correct workflow step.
If fields are hidden by configuration, contact your PMS admin to confirm settings.
Still stuck?
Capture the rejection reason text and the codes you tried.
Reach out to the DocStation Support team via chat along with claim details.
Safety and compliance reminders
Use overrides only when appropriate under payer rules and organizational policy.
Overrides do not bypass documentation requirements.
Maintain records supporting the use of each override.