Thursday, March 27, 2014

NDC code - format - how many digit, qualifier information

NDC Billing  Instructions 

Molina EDI Help Desk is reporting claims are being rejected because more than one NDC code is being billed on one service line.  Below you will find instructions on billing multiple NDC codes for the same drug on a claim. For more detailed information on billing NDC codes, please see the BMS website at www.wvdhhr.org/bms under the heading “HCPCS/Drug Codes”. On this site, you will find a listing of drug codes and whether or not they require a NDC, there is also Frequently Asked Questions, a provider notice and a list of manufacturers that participate in the rebate program.

NDC‟s must be configured in what is referred to as a 5-4-2 format. The first segment must include five digits, the second segment must include four digits, and the third segment must include 2 digits. If an NDC is missing a number on the product label, the appropriate number of zeros must be added at the beginning of the segment. Only the NDC as specified on the label of the product that is administered to the member is to be billed to the program. Every NDC must be billed with an N4 qualifier before the NDC with no hyphens or spaces, the unit qualifier such as F2 (International Unit), GR (Gram), ML (Milliliter), and UN (Unit) and the NDC quantity. Billing instructions are available at www.dhhr.wv.gov/bms & Molina Medicaid Solutions at www.wvmmis.com. Important: All NDC charges must have the specific date of service the listed drug was administered and all NDC drug charges must be listed individually.

Multiple NDCs 

At times, it may be necessary for providers to report multiple NDCs for a single procedure code. For codes that involve multiple NDCs (other than compounds, see BMS website), providers must bill the procedure code with KP modifier and the corresponding procedure code NDC qualifier, NDC, NDC unit qualifier and NDC units. The claim line must be billed with the charge for the amount of the drug dispensed for the NDC identified on the line. The second line item with the same procedure code must be billed utilizing KQ modifier, the procedure code units, charge and NDC information for this portion of the drug.

Service Dates 

All NDC drug charges must have the specific date of service the listed drug was administered and all NDC drug charges must be listed individually. (Block 24A CMS 1500, Block 45 on UB04).

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