Wiki NDC# with Pediatric Immunization

[IshratKhurshid]

Hi,

We aren't reporting NDC numbers with Immunization Procedures for a Pediatric clinic. Almost all payers are paying them without the issue, we saw a recent denial from a commercial payer for missing NDC number on a claim for Flu vaccine. Having said that I just want to confirm the general concept of reporting NDC with vaccination codes. Is it required for all payers, commercials or govt. payers? can we get away with this ? or should we be getting recoupements at some point for missing NDCs paid claims?

Thanks!

 

[HangarPilot]

We only report NDCs for payers that require it. For the longest time, Tricare was our only payer requiring them. Recently, certain United Health Care plans have started requiring them. It wouldn't surprise me to see more payers jumping on the bandwagon.

We don't routinely report them to all payers for two reasons:
1) It's just another thing that can go wrong and get a claim denied is we make a mistake since we have to manually do it one at a time.
2) As a participant in the Vaccines for Children (VFC) program, we have two different vaccine supplies. Depending on eligibility, a patient may get the Hepatitis B vaccine purchased by our office (a Merck product) or the "free" vaccine paid for by the CDC (a Glaxo product). Therefore we cannot enter the NDC in our system and have it automatically added every time ... we need to manually enter it at the claim level based on which brand/NDC was actually used. Needless to say that's a bit of a hassle so we don't do it except when we have to!