Tricare vaccine NDC numbers

tkiehl

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Can anyone help with NDC numbers for Tricare? I am using the 5-4-2 rule and placement of the extra 0 since the numbers are all 10 and 11 are needed. They are denying some as invalid numbers, but they can not tell me what numbers are valid when I call them. I'm at a lose of what to do and holding thousands of dollars of vaccine claims trying to get this worked out. Thanks!
 

Kisalyn

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We enter the ten digit NDC#, but maybe our EHR does the conversion before the charges are sent out. So when you bill the exact same NDC# to Tricare and another insurance, it's only Tricare that's denying?
 
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tkiehl

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Tricare is the only one we submit to that requires the NDC, and it is only since they changed to UHC that they have required us to do this. So this is all new to us and very confusing.
 
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I remember assisting a practice that had this issue a few years back. It turned out to be an extra zero. I had to contact the manufacturer to find out where to place the zero. It was somewhere in the middle of the number. 5th or 6th character if I remember correctly.
Good Luck.
 

denarh40

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Tricare NDC denials

We have had to put the 0 in the NDC for Tricare. However, today I made several calls and learned that the CDC lists the NDC on the box the vaccines come in and not the NDC on the vial/dose itself which is what we had entered. Tricare could not locate that NDC on the CDC website so denied it. I don't know if that is your problem you are having but wanted to share if it helps.:)
 

Kar116

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RE: Tricare denial of NDCs

I haven't had any Tricare claims requesting this but mostly with Medicaid claims. Our understanding is using N4 in front of the NDC number shown on the vial/syringe box and ML1 for your units.
Example:N458160081011ML1. I write it on the paper claim in the red shaded box where all the codes are listed. Maybe that will take care of it? If not, talk to a claims adjustor who will actually explain it to you than a customer service rep. Good luck!
 

Michele Price

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Please help?

We are having issues as well with Tricare. I think you are correct in saying to use the N4 in front of the NDC.

Anyway, I need some clarification on one thing mentioned in this forum. We are getting denials from Tricare and BCBS and was advised by the manufactures that we are to be reporting the package NDC's? I could be wrong, but I thought we are to be using the actual NDC from the syringle/vial and not the package or box? BCBS states we are to be using the actual viral or syringe, but the manufactures are reporting the box/package. What do we do?

Can someone answer this and lead me to where it is clarified by CMS that we are to use the package or box NDC?
 

lburke31

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I have a diagram from Tricare showing where the 0 goes. if you reply w/ your fax I will send you it to you on Monday. I file all my Tricare claims on their website and have few errors. if an error is made you can correct it before you submit. lburke cpedc
 
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