National Drug Code (NDC) Claim Edits: October 1, 2017

National Drug Code (NDC) Claim Edits: Oct. 1, 2017

8/17/2017

BlueCross BlueShield of South Carolina and BlueChoice® HealthPlan of South Carolina require providers to file a valid NDC with the unit of measure and quantity for all professional and outpatient administered drug claims. This applies to institutional outpatient and professional services billed. 

We began educating on the significance and necessity of filing the NDC appropriately in March 2015 and effective Oct. 1, 2017 we will begin applying claim edits to applicable services that have been submitted without the corresponding NDC.

What does this mean for you?

Beginning Oct. 1, 2017, the NDC must be submitted for all professional and outpatient administered drug claims. If the NDC is missing, incomplete or invalid, the charges will be denied.

What is the NDC?

The NDC is a universal number that identifies a drug. The NDC number consists of 11 digits in a 5-4-2 format. The Federal Drug Administration (FDA) assigns the first five digits, which identify the manufacturer of the drug. The manufacturer assigns the remaining digits, which identify the specific product and package size. Some packages will display 10 digits for the NDC. This needs to be converted to an 11-digit NDC. Refer to the “How do I bill the NDC?” section to determine how to convert a 10-byte NDC to an 11-byte NDC.

You’ll find the NDC on the drug container (vial, bottle or tube). The NDC you submit to us must be the actual NDC number on the container from which you administered the medication. If a drug is administered from a vial, for example, you should use the NDC on the vial. Do not bill for one manufacturer’s product and dispense another. Do not bill using invalid or obsolete NDC numbers.

How do I bill the NDC?

Submitted NDCs must be valid and have 11 digits following the 5-4-2 format. If the package or container lists an NDC with 10 digits, this must be converted to an 11-digit NDC. To do this, first determine the format of your 10-digit NDC by examining the package information and counting the numbers separated by dashes. Once you have identified the format as either 4-4-2, 5-3-2 or 5-4-1, insert a zero according to this table:

 

10-Digit Format

 

Add a zero in...

 

Report NDC as

4-4-2 

*####-####-##

1st position

0####-####-##

0##########

5-3-2

#####-*###-##

6th position

#####-0###-##

#####0#####

5-4-1

#####-####-*#

10th position

#####-####-0#

#########0#

 

Note: Asterisk (*) denotes missing digit in 11-digit (5-4-2) format.

Read more about the NDC filing requirements here. If you have any questions about the NDC, please contact Provider Education at 803-264-4730 or submit your question using the Provider Education Contact Form.