In the October 2020 edition of Provider News, we 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 and after December 16, 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 Healthcare Common Procedure Coding System (HCPCS) code or Current Procedural Terminology (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. 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.  

 

As we shared in the original notification, we will deny any line items on a claim regarding drugs that do not include the above information – effective for dates of service on and after December 16, 2020.  Please include the above information on drug claims to help ensure accurate and timely payments.

 

If you have further questions, please contact the telephone number on the back of the member’s ID card.

 

780-1220-PN-MENH



Featured In:
December 2020 Anthem Maine Provider News