NC Medicaid would like to remind all providers about requirements for pharmacy revenue codes which require both a National Drug Code (NDC) and a Healthcare Common Procedure Coding System (HCPCS) code.
To adhere to federally required rebate guidelines, NC Medicaid requires the submission of a HCPCS code with an NDC on all drug claim lines with Revenue codes 0250-0259 and 0631-0637 submitted on outpatient hospital institutional claims (which are billed on a UB-04 or 837-I).
Providers should begin including HCPCS codes on the outpatient drug claim lines immediately. Within NCTracks, claim lines will begin to deny effective May 1, 2022, if the HCPCS code is not present when an NDC is billed for a drug on an outpatient hospital claim line. Providers must use Centers for Medicare and Medicaid (CMS) guidance and industry standards to associate the correct NDC to its correct HCPCS code.
Note: There was an issue where claims were paid for some of the above revenue codes when a HCPCS code was not present. This was an error, which will be corrected in NCTracks for future claims processing, but NC Medicaid would like to remind providers of the requirement for both NC Medicaid Direct and NC Medicaid Managed Care to include both the NDC and HCPCS for institutional outpatient hospital claims.
Contact
NCTracks Call Center: 800-688-6696