In a letter dated September 27, 2019, Anthem Blue Cross (Anthem) notified providers about a new billing requirement to help us determine the correct amount to pay on drug claim lines for commercial professional and facility outpatient claims filed to us.  As a reminder, effective for dates of service on or after January 1, 2020, the following information will be required on claims for all categories of drugs except for those administered in an inpatient facility setting:


  1. Applicable HCPCS code or CPT code
  2. Number of HCPCS code or CPT code units
  3. Valid 11-digit National Drug Code(s) (NDC), including the N4 qualifier
  4. Unit of Measurement qualifier (F2, GR, ML, UN, MG)
  5. NDC units dispensed (must be greater than 0)


Note: These billing requirements apply to Local Plan and BlueCard® only.  The Federal Employee Program® (FEP®) and Coordination of Benefits/Secondary claims are excluded.


As we shared in the original notification, Anthem will deny any line items on a claim regarding drugs that do not include the above information – effective for dates of service on or after January 1, 2020.  Please include the above information on drug claims to help ensure accurate and timely payments.


If you have specific claims questions, please call the phone number on the back of the member ID card.  Other questions can be directed to our Provider Service staff at 1-800-677-6669.

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January 2020 Anthem Blue Cross Provider News - California