Wiki injectables unclassified biologic

[Tewisdom]

caresource marketplace denied J3590 injectable for invalid ndc

 

[bhardwajv]

Could you please share the NDC number you are using and for which biologic you are using J3590?

 

[TazConsulting]

This is the one I am using for BCBS and it is denying as well
00024-5915-20
How many units should I be billing?

 

[jessicaw412@gmail.com]

We are also having issues with Avastin J3590 for Ophthalmology use with all Caresource IN plans. They are denying due to NDC: 50242-0060-01 for compounded Avastin 1.25mg, billed with 1 unit stating "M119 - Missing/incomplete/invalid/ deactivated/withdrawn National Drug Code (NDC).". We have filed disputes including Caresource's pharmacy policy that states "J3590 will be reimbursed as follows, when billed with NDC 50242-0061-01 or 50242-0060-01: 1. For units 1 to 1.25, reimbursement is up to $70.00 per eye, per calendar month." Caresource is denying our disputes stating "50242-0060-01 is an invalid NDC code ". Have you had any luck getting Caresource to process claims correctly?