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John,
I
interpreted the addenda in the same way. I sent the following to the [EMAIL PROTECTED] email address
on June 27 to have this confirmed and I have never received a
response.
"The addenda rule stated
that there was no named standard for drugs and biologics, so both HCPCS and NDC
codes could be used since they are both valid in the 837P implementation guide.
The comments state that the NDC codes can be used if both trading partners agree
to it. On page 56 (original page 401) and on page 71 of the IG addenda, the note
says: "The NDC number is used for reporting prescribed drugs and biologics when
required by government regulation, or as deemed by the provider to enhance claim
reporting/adjudication processes."
Can a Medicaid require a provider to send NDC codes on an 837P
claim with no negotiation if there is no state regulation requiring it?"
Betsy Clore
Wake
Forest University Health Sciences
WFU Physicians Information
Systems
Miriam, I have not heard of a similar requirement for Alabama Medicaid.
The state has converted local codes to use J codes. The way I
understand the implementation guide is that NDC is only used "when
required by government regulation" or "as deemed appropriate by the provider
to enhance reporting/adjudication processes". So, IMO, unless Indiana or
any other state has a regulation to require use of the NDC, the facility
should not have to report NDC unless it chooses to.
John
Craft
Partner, HCS
866-271-1359
In
a recent provider workshop conducted in Indiana by AdminaStar Federal
(Medicare FI), the following issue came up.
The representative for AdminaStar
Federal confirmed that Medicare will not require NDC codes
for drugs (i.e., "J" codes will work). She went on to say that
Medicaid, however, says it will require NDC
codes. Members
of the hospital's billing
staff were told at a Medicaid
workshop (held during the week before) that because
the new claim field isn't big enough to contain the entire NDC code, the
last couple of digits of the NDC code should be placed in another
field. A related question involves how "cross over" claims will be
handled between Medicare and Medicaid when NDC codes are
involved.
Are the rest of you
running into this in other
states?
Best
Regards,
Miriam J. Paramore
President & CEO
Co-Founder and President
PCI: e-commerce for healthcare
HAWK - HIPAA Action Workgroup of Kentucky
9001 Shelbyville
Road
www.hawkonline.org
iTRC Building
Louisville, KY 40222
ph
502-429-8555 fax
502-852-4701
www.hipaasurvival.com
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