generated: '2026-08-14'
method: searched
source: https://rxdocs.fuzehealth.com (Copay Reject Codes, Triaged Copay Requests, Copay Prescription Rejection Codes)
provider: Truepill
providerId: truepill
applicability: >-
  FuzeRx is not a card acquirer, but it IS an authorization/adjudication provider:
  POST /v1/copay_request submits a patient's insurance and prescription details to
  a pharmacy benefit manager and returns a real-time out-of-pocket determination.
  The rejection codes below are the pharmacy-benefit equivalent of card decline
  codes, and they are what an integration must branch on to tell "the patient owes
  $X" from "this claim will never adjudicate".
summary: >-
  Copay adjudication is asynchronous. POST /v1/copay_request returns 202 Accepted;
  the determination — or the decline — arrives as a COPAY webhook event. A decline
  carries status = error and a string code in details.error_code. A recoverable
  hold carries status = triage and a CT-prefixed code in details.code.
envelope:
  field: details.error_code
  callback_type: COPAY
  status_values:
  - success
  - error
  - triage
  triage_field: details.code
  additional_detail_field: details.additional_information
decline_codes:
- code: DUPLICATE_REQUEST
  meaning: Duplicate Request
  action: >-
    A copay request for this patient/prescription is already in flight. Do not
    resubmit — poll GET /v1/copay_request/{request_id} or wait for the original
    event. This is also the closest thing FuzeRx has to an idempotency signal.
  terminal: true
- code: CLOSED_NETWORK
  meaning: Closed Network
  action: The plan does not permit this pharmacy. Route the fill elsewhere or collect cash-pay consent.
  terminal: true
- code: PHARMACY_OUT_OF_NETWORK
  meaning: Out of Network
  action: The dispensing pharmacy is out of network for this plan. Offer cash pay or an in-network alternative.
  terminal: true
- code: PHARMACY_OUT_OF_NETWORK_STATE_MEDICAID
  meaning: Out of Network
  action: Out of network specifically for a state Medicaid plan. Medicaid rules usually bar cash-pay substitution — escalate to a human.
  terminal: true
- code: INSURANCE_TERMINATED
  meaning: Coverage Terminated
  action: Collect current coverage from the patient and create a new insurance object before retrying.
  terminal: true
- code: BAD_INSURANCE_DETAILS
  meaning: Bad Insurance Details
  message: List of the selected insurance issues
  action: >-
    Read the accompanying message to learn which of BIN / PCN / group number /
    cardholder ID / DOB is wrong, correct it, and submit a new copay request.
  terminal: false
- code: CUSTOMER_CANCELLATION_REQUEST
  meaning: Copay Cancelled by Customer Request
  action: The request was cancelled via POST /v1/copay_request/cancel. No further action.
  terminal: true
- code: PA_REQUIRED
  meaning: Prior Authorization Required
  action: >-
    Submit POST /v1/prior_authorization, or set initiate_prior_auth = true on the
    copay request so FuzeRx initiates and handles the PA itself (the request then
    moves to triage code CT003 instead of declining).
  terminal: false
triage_codes:
- code: CT001
  meaning: Clinic Outreach
  additional_information: Description/reason of clinical outreach
- code: CT002
  meaning: Customer Clarification needed
  additional_information: May include a description of the desired clarification
- code: CT003
  meaning: Prior Authorization needed
  additional_information: May include a description of the prior authorization
- code: CT004
  meaning: Refill too soon
  additional_information: Date when the medication can be filled
- code: CT005
  meaning: Pending internal transfer
- code: CT006
  meaning: Other Reason
  additional_information: Specifics of reason
- code: CT007
  meaning: Coverage Terminated
- code: CT008
  meaning: Coverage Not Effective
- code: CT009
  meaning: Date of Birth Mismatch
- code: CT010
  meaning: Bad Insurance Details
  additional_information: "May include: Missing/Invalid Group Number, Non-Matched Cardholder ID, Missing/Invalid PCN, Missing/Invalid DOB, Invalid BIN"
masked_to_patients:
  documented: false
  note: >-
    The documentation does not state which codes may or may not be shown to a
    patient. Because these codes carry benefit and coverage facts about a named
    individual, treat the raw code and message as PHI and surface only the
    remediation, not the code, in patient-facing UI. This is our guidance, not a
    published provider rule.
decline_code_count: 8
triage_code_count: 10
related:
- errors/truepill-problem-types.yml
- errors/truepill-error-codes.yml
maintainers:
- FN: Kin Lane
  email: kin@apievangelist.com