Effective Jan.1, 2018 – National Drug Code is Required When Submitting These Types of Claims

November 06, 2017 -

National Drug Code Required When Submitting Claims for Drugs Covered Under the Medical Benefit, Effective Jan. 1, 2018

Any professional or institutional outpatient facility claim submitted with a date of service on or after Jan. 1, 2018 that includes drugs covered under the medical benefit with an assigned HCPCS code must also include the National Drug Code (NDC) number, quantity and unit of measure.

NDC, a universal number that identifies a drug, is the industry standard identifier for drugs, and this change will allow us to more accurately track medications that are being administered.

No other part of the claims submission process will change. You should continue to include the HCPCS and CPT® code on your claim.

When is the NDC information required to be submitted?

Claims submitted with a date of service on or after Jan. 1, 2018, must include this information. This requirement will apply to claims submitted both electronically (submit in LIN03) or on paper claim forms CMS-1500 (submit in Box 24D) and UB-04 (submit in FL43). More details are outlined on this chart.

Note: This change applies only to Professional & Institutional Outpatient Facility claims at this time.

If the required NDC information is not included on claims for dates of service on or after Jan. 1, 2018, your claim will be denied by CareFirst.