Agencies
Services
Provider Notice issued 06/16/05
Requirement of National Drug Codes (NDC)
| To: | Participating Medical Assistance Providers |
| Date: | June 16, 2005 |
| Re: | Requirement of National Drug Codes (NDC) |
Effective with dates of service on or after August 1, 2005, the department will require the 11- digit NDC be reported for administered or dispensed drugs. This requirement will apply to electronic claim submissions using the HIPAA 837P or Direct Data Entry through the MEDI System, as well as paper claim transactions submitted on forms DPA 2360 (Health Insurance Claim Form) and DPA 1443 (Provider Invoice). This requirement does not apply to drugs that are billed on the UB92 and the 837I. In order to ensure that the appropriate reimbursement is made, please follow the billing instructions outlined below.
HIPAA 837P Transactions and Direct Data Entry through the MEDI System
The department will continue to require that the Health Care Procedure Coding System (HCPCS) codes be supplied to supplement NDC codes for administered or dispensed drugs. Billing instructions for electronic claim transactions can be found in Chapter 300, Topic 302, located on the department's Web site at:
Paper Transactions
The department will require both the HCPCS code and NDC for administered or dispensed drugs. Providers must report the HCPCS code, units (quantity) and charges on one service line and report the NDC on another service line. The NDC service line must always follow the drug HCPCS code service line.
Please remember, coverage of prescription drugs is limited to products from companies that have signed Rebate Agreements with the Centers for Medicare & Medicaid Services (CMS). A listing of Pharmaceutical Labelers having signed Drug Rebate Agreements may be found on the department'’s Web site at:
Providers wishing to receive E-mail notification, when new provider information has been posted by the department, may register at the following IDPA Web site:
Questions regarding this notice may be directed to the Bureau of Comprehensive Health Services at 1-877-782-5565.
Anne Marie Murphy, Ph.D.
Administrator
Division of Medical Programs