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problems getting J0696 paid with Medicaid

  1. Default problems getting J0696 paid with Medicaid
    Medical Coding Books
    I'm having trouble with Medicaid paying the Rocephine injection. They keep denying the injection due to the NDC code being invalid. I'm lost, I'm using the NDC code from the vial. Is anyone else having the same problem with Medicaid? Any help or suggestions would greatly be appreciated.


  2. #2
    Your best bet would be to contact them and find out more info as to why it is incorrect. I had a similar issue with an insurance and I had pulled the number right off the vial. Apparently it still needed an extra 0 that I didn't have in the number. Talk to them and if you have any issues try to talk to your provider rep.
    Herbie W Lorona Jr., CPC, CPC-H

  3. #3
    Honolulu, HI
    Default ndc
    in my experience with Medicaid and NDC, my state's MCD wants an 11 digit NDC and it has to be in the gray shaded area above the line item it references with the N4 qualifier, no spacing. as stated in the previous post, check with your state's medicaid contractor first though.

  4. #4
    Columbia, MO
    Yes the N4 qualifier must be first then the 11 digit NDC number with no space. Then a space and the drug name and then 3 spaces and the package code such as ml or gr or un.

    Debra A. Mitchell, MSPH, CPC-H

  5. Default
    Thank you all for your help, I will try entering the info on the claim as suggested, and if the claim still denies I will contact Medicaid directly.

    Thanks Again.

  6. Default
    One additional note- some states, in AL where I am, Medicaid has a drug list that they will cover and those brands and the applicable NDC are the only ones they will pay for. So let's say your are buying Rocephin from one supplier and that one has an NDC#, Medicaid may have a list that does not list that brand/maker included as a preferred drug. Check with your particular state to see if they have a specific drug list that Medicaid providers must prescribe from.....

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