There has been an increase in claim rejections for invalid NDC codes. The following information will assist in identifying NDC codes that are not valid.
If you submit an 837 EDI transaction with an invalid NDC code, it will reject the entire claim. You will need to review your rejections on the BRR report to know which NDC code is invalid. A claim with invalid NCD code can be submitted successfully on the Health PAS Online Portal, but the claim lines with the invalid NDC codes will deny.
NDC codes should be 11 digits long and have a 5 4 2 format (example: 00703-5145-01). When adding NDC codes to your claims, hyphens are not needed, but 11 digits are required.
There are two Medicare crosswalks to validate NDC codes that are used to edit claims in MIHMS. If the code combinations are not on either of these crosswalks, then the claim will not process accurately.
Please see the links for the Medicare crosswalks:
There will be occasions when the HCPC/NDC combination is on one list but not the other. There will always be a delay with keeping both lists current so, the MaineCare uses both lists to validate these combinations. These codes are Date of Service sensitive; therefore, the relationship start and end dates on the PDAC crosswalk matters. When using the Medicare ASP Crosswalk, choose the quarter that includes the Date of Service.
If claims are denied due to the invalid NDC/HCPCS codes, you can request the combination to be reviewed, and possibly added by using the NDC-J Code Combination Request Form and by emailing the information to MaineCareNDCrequest.DHHS@maine.gov