What this article covers
This article explains the claim edit overrides supported in DocStation’s BIN billing. It covers what each override does, when to use it, and the exact DUR/PPS codes to enter.
Important to know
Overrides allow claims to proceed only when payer policy permits. They do not guarantee payment, bypass documentation requirements, or override payer coverage rules. Claims should still be reviewed after payer adjudication.
💡 Quick Glossary: What do these terms mean?
💡 Quick Glossary: What do these terms mean?
Claim edit
A validation that blocks or warns claim submission based on payer or policy rules.
DUR/PPS override
Three fields entered on the claim to allow it to proceed when the payer policy permits.Intermediary authorization override
A separate override method is used in specific workflows (e.g., eligibility bypass).
📌 How to Enter DUR/PPS Overrides
Open the claim showing the rejection message
Locate the DUR/PPS segment in the PMS claim form
Enter the three codes in order
Example:
ER/00/1B
Resubmit the claim
Review the response message
Tip: If the claim still rejects, review the rejection message for additional requirements or contact our Support Team
Supported BIN Billing Overrides
Rejection / Scenario | When You’ll See This | What to Enter | Result |
Not Typically Covered by Medicare Part B | A vaccine is billed to a Medicare payer PCN when the service is not typically covered under Part B. | DUR/PPS: | PMS Claim proceeds to create a DocStation Medical claim if otherwise valid. |
Eligibility Check Overrides (Including Medicare Advantage Rejections) | Eligibility check fails or cannot be confirmed at the time of submission, or the payer requires an override for plan-specific coverage (for example, a vaccine covered only under certain plans | Option 1: In the Intermediary Authorization Override field → | Eligibility check is skipped, and the PMS claim proceeds to create a DocStation Medical claim if otherwise valid. |
Reverse Claim Override (PMS Reversal Enablement) | You need to reverse the claim in your dispensing software (PMS) and rebill to the PBM, while keeping the DocStation medical claim unchanged. | DUR/PPS: | Enables reversal in the PMS only. No change is made to the DocStation Medical claim. |
Refill Too Soon | Refill attempted 7 or more days before the previous span end date. | DUR/PPS: | PMS Claim proceeds with a paid response and creates a DocStation Medical claim if otherwise valid. |
Prior Authorization (PA) Required | Claim includes mapped HCPCS that require prior authorization. | If PA is on file: | PMS Claim proceeds with a paid response and creates a DocStation Medical claim if otherwise valid. |
⛔ Hard Stops (No Override Available)
Rejection | When You’ll See This | Required Action | Result |
Diagnosis Code Required | Non-vaccine mapped HCPCS is submitted without a diagnosis code in Clinical Segment Field 404-DO. | Add a valid diagnosis code. | Claim submits once the diagnosis code is provided. No override is available when this edit is enabled. |
⚠️ Important Notes About Reversals
Action Taken | What Happens |
Reverse Processing or Submitted claim in PMS | Allows editing in the PMS only. Does not affect DocStation or the payer. |
Reverse Paid claim in PMS | Cancels the claim in DocStation but does not cancel it with the payer. |
Edit & resubmit claim in DocStation | Does not update the PMS. A new claim must be created in the dispensing software if synchronization is required. |
🛠️ Still Stuck? Contact Support
🛠️ Still Stuck? Contact Support
If an override did not work:
Capture the rejection message
Note the codes you attempted
Contact DocStation Support via chat with claim details (Date & Patient RX number)