August 2008 Newsletter

NDC Recap

By: Manager, EDI Edits & Documentation Group

Over the past few months, there has been a noticeable increase in the number of clients dropping NDCs into Xpeditor with incorrect formats. In an effort to proactively help ensure the proper submission of NDCs, the following recap of NDC information has been compiled from previous Connections articles:

"NDC" is the acronym for National Drug Code. It is an 11-digit number that identifies a specific drug and provides additional information about that drug. The NDC number is composed in a 5-4-2 format. The first five digits identify the labeler/manufacturer of the drug and are assigned by the Food and Drug Administration (FDA). The remaining digits are assigned by the manufacturer, and identify the specific product and package size: specifically, the second segment identifies the product, product’s strength, dosage form and formulation, while the third segment identifies the package size of the drug.

For UB claims, the actual NDC Code will be extracted from the RCC Description field. It must be entered in one of the following formats: NDC: + 1 space + the 11 digit NDC Code OR N4+11-digit NDC Code (which is based on the most recent NUBC billing specifications). Please note that the NDC Code is sent in the LIN ANSI segment with a N4 Qualifier. For 1500 claims, the 11-digit NDC code should be entered in the "NDC Code" field on the charge line.

UB edit "U43001 - NDC Code Required OR Invalid Format" and 1500 edits "197001 - NDC Missing" and "197002 - NDC Invalid" are in place to ensure the proper submission of an NDC on all Medicare claims and select Medicaid claims. The edits will be applied to other payers as required.

There are three NDC-related fields in the charge lines of both the UB and 1500 Claim Form Replicas in Xpeditor:

NDC Unit of Measure—A qualifier indicating the type of measurement used for the drug. The valid qualifiers are:

• F2 – International Unit
• GR – Gram
• ML – Milliliter
• UN – Unit

NDC Quantity—The actual Quantity/Unit entry for the drug being billed. This must be a numeric value.

NDC Unit Price—The Unit Price of the drug.

When an NDC number is reported, providers must also record all supporting information, such as the unit of measure, quantity, and cost. If all of the supporting information is not provided and an NDC is on a claim, our entire file will be rejected. Appropriate edits have also been created to be raised on both UB and 1500 claims that do not have all the necessary information.

As usual, if you have questions or concerns about the proper use of NCDs, please contact either your Service Representative or the Quadax Client Support Center.