National Drug Code requirement on outpatient claims

Anthem Blue Cross and Blue Shield (Anthem) values the quality and commitment with which you serve your patients and our members. In this edition of Provider News, we are notifying you about a National Drug Code (NDC) requirement for drugs administered in a physician’s office or outpatient facility setting for Local Plan and BlueCard member claims only. This notice EXCLUDES claims for members enrolled in the Blue Cross and Blue Shield Service Benefit Plan (also called the Federal Employee Program or FEP) and Coordination of Benefits/secondary claims.  

 

For dates of service on or after November 1, 2019, all providers are required to supply the 11-digit NDC – along with the information below – when billing for injections and other drug items on the CMS-1500 and UB-04 claim forms as well as on 837 electronic transactions.   

1. The applicable HCPCS code or CPT code
2. Number of HCPCS code or CPT code units
3. The 11-digit NDC(s), including the N4 qualifier
4. Dosage Unit of Measurement (F2, GR, ML, UN, ME)
5. Number of NDC Units dispensed (must be greater than 0)

 

To ensure accurate and timely claims payments, it is important that you provide the NDC information as outlined above when filing claims to us. Anthem will reject any line items on claims with dates of service on or after November 1, 2019, when the above information is not included regarding drugs.

 

If you have further questions, please contact your Anthem network relations consultant or refer to the Georgia Provider Manual.