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August 10, 2018

National Drug Code (NDC) Claim Editing UPDATE

EDI Front End editing was implemented Monday, 08/06/2018. Based on the high volume of rejections, this edit has been changed from a rejection to a warning for a period of 60 days. Additional communication and education will be provided regarding NDC Codes during that time.

Prior to the edit moving from a warning to a rejection, notification will be posted.

Claims submitted 08/06/2018, 08/07/2018, or 08/08/2018 that rejected on the 277CA with an A3:275, and a 999 that indicated a rejection due to an NDC code can now be resubmitted.

The HIPAA standard NDC format requires 11 digits but the FDA only assigns 10. A leading 0 must be added to the appropriate segment to bring the total to 11. There are three segments; the first identifies the packager of the product and will have 4 or 5 digits, the second identifies the drug and will have 3 or 4 digits and the third represents the package size and will have 1 or 2 digits. A leading zero must be added to the appropriate segment to bring it to the 5-4-2 HIPAA format. Here are some examples:

5555-4444-22 would become 05555-4444-22 submitted in the 2410 LIN 05555444422

55555-444-22 would become 55555-0444-22 submitted in the 2410 LIN 55555044422

55555-4444-2 would become 55555-4444-02 submitted in the 2410 LIN 55555444402

 

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