New NDC Requirements For Medi-Call

The Federal Deficit Reduction Act of 2005 (DRA) requires that all state Medicaid agencies collect rebates from drug manufacturers for physician-administered or physician-dispensed drugs.

Effective for dates of service on or after April 1, 2009, Medi-Cal will need to collect the National Drug Codes (NDCs), in addition to the customary Healthcare Common Procedure Coding System (HCPCS) Level I, II or III codes on claims submitted for physician-administered drugs.

Changes apply to hospitals, physicians and clinics

Changes apply to 837 electronic transactions for Institutional and Professional claims, CMS-1500 and UB-04 paper claims, Point of Service (POS) device, Internet Professional Claims Submission (IPCS) system

The NDC number consists of 11 digits in a 5-4-2 format: five digits in the first segment, four digits in the second segment, and two digits in the last segment. Leading zeros are added wherever they are needed to complete a segment with the correct number of digits.

When a provider uses more than one NDC for a drug, the provider must include all NDCs on the claim. The quantity for each NDC must be reported separately by repeating the HCPCS code.

Medi-Cal provider manuals, the CMS-1500 and UB-04 eLearning Tutorials and electronic transaction companion guides will be updated with instructions for billing HCPCS and NDC. These resources will also be updated to include claim form completion instructions for placement of the NDC on claims.

Our 837Direct application is capable of supporting this requirement.

Should you have questions, please call the Telephone Service Center (TSC) at 1-800-541-4555 and choose the prompt appropriate for your provider type or you may contact us at support@medtrandirect.com