Wiki NDC numbers and Medicaid

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Chill74

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Weatherford, Texas
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I have several claims on hold due to NDC number invalid or missing. The NDC number is there so I am at a loss as to what they are wanting. Any help or suggestions are welcome.
 
The NDC number must be 11 digits and the zeros must be in the correct 5-4-2 segment in order for the number to be valid. The payers also require the correct quantity and unit of measure. Your Medicaid plan probably offers a document on how to do this, or if you can provide one of the numbers you are submitting along with the name of the drug, perhaps we could validate it for you.
 
Agree with thomas7331. To add a couple of things to check out - Our state Medicaid and Medicaid Advantage programs here maintain their own (incomplete) list of NDCs and will only accept one of those NDCs. If it's not on their list, they deny it as an invalid code. Doesn't matter if that's what you had in stock or not. We've had to appeal a large number of drug claims (successfully, I might add) by arguing that we can't report an NDC for product we did not have in stock and proving the number we submitted was correct. Our Medicaid plans also require that NDC's be reported for each vial used, which requires splitting the charge to several lines in order to correctly report billing units and NDC for each vial.
 
thomas7331 said:
The NDC number must be 11 digits and the zeros must be in the correct 5-4-2 segment in order for the number to be valid. The payers also require the correct quantity and unit of measure. Your Medicaid plan probably offers a document on how to do this, or if you can provide one of the numbers you are submitting along with the name of the drug, perhaps we could validate it for you.
Click to expand...
this is an example ; 00085-4320-01
 
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