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Nexplanon : Reimbursement issues

  1. #1
    Default Nexplanon : Reimbursement issues
    Medical Coding Books
    We have received rejections from Michigan Medicaid and two of the Medicaid managed care plans stating that we have an invalid NDC. But we do not. This seems similar to an issue we had earlier this year with Depo Provera. We are assigning J7307, NDC 0052-0274-01. It seems like we've had nothing but trouble with rejections for contraception since the ACA. Any one else experiencing these issues?

  2. Default Nexplanon issues
    I've had similar issues with Nexplanon and Arkansas Medicaid. Contact your local provider rep and verify there's not a specific format for the NDC code. For example, Arkansas medicaid requiries we have a 5-4-2 format so we have to add a zero at the beginning of the NDC. Also, there is a specific NDC form that we have to fill out and attach to the claim as well. I would make sure your state doesn't have odd requirements like these. Good luck!
    Angie Tibbett, CPC

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