July 2018

How to Keep the Cash Flowing: Filing Claims with NDCs

Although providers may bill with National Drug Codes (NDC), invalid NDCs, invalid HCPC-NDC combinations and a lack of NDCs are all causes for claim rejections.

To help reduce rejections based on incorrect HCPC-NDC combinations, providers should use the value in Column J (NDC Package Measure) from the Texas NDC-to-HCPCS Crosswalk.

If the NDC information is missing on the billed claim or the NDC is not valid for the corresponding HCPCS code, Blue Cross and Blue Shield of Texas will deny the entire claim for failing to comply with Clean Claim Standards. Standards can be found in our provider manuals:

• STAR Kids
• STAR/CHIP

If you bill Rev Code 0630-0636, an NDC is required. If an NDC is not present with Rev Code 060-0636, the claim will be rejected.

If you provide family planning services, long-acting reversible contraceptives (i.e., intra-uterine devices, hormone patches, vaginal rings and sub-dermal implants) are included and require NDCs for billing.

Claims Tips

Review tips on how to submit claims for provider administered drugs. There are sample sections of the CMS-1500 and CMS-1450 for review when billing with NDCs. We also provide tips for electronic filing and billing with multiple NDCs.

You may also visit our provider manuals for more information on billing and NDCs at:

• STAR Kids
• STAR/CHIP