# NDC and BCBS



## Sovacool (Apr 18, 2014)

Hi All,

I have a problem with BCBS denying claims because of "Invalid NDCs codes" the problem is they're are valid codes. In the correct 11 digit format straight from the vial. Whenever I called, all I get from the Rep. is " please submit a valid code" I have Encoder and NDC crosswalk and my codes from the vial aren't listed. I double checked with the Rx and they aren't compounded drugs.
I've tried calling and sending the claims with an invoice with the NDC listed but I'm not successful getting these paid. Anyone have any ideas. I no I legally can't change them to an NDC that's not on the vial but that's what my MD wants. Thoughts?


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## mitchellde (Apr 18, 2014)

the NDC number needs an N4 qualifier in front of the number making the number a total of 13 characters.  could that be the problem?


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## Sovacool (Apr 18, 2014)

Nope, it has the N4 but thanks.


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## wfriddle (Apr 18, 2014)

I am sure you probably already added a "0" place holder if necessary to assure the required 5-4-2 format. If so what I would do is call Blue Cross back and ask to speak to a supervisor or someone who can explain further. Or have them direct you to the proper place, usually on their website, that sites their requirements for proper NDC submittal. I have had issues where for some reason a claim did not have the NDC on it when it when out and trying to get it added/corrected has been difficult. Several phone calls and denials later, fingers crossed, they should be paying. Good luck!

http://www.bcbsil.com/pdf/pharmacy/ndc_billing_guidelines.pdf

This is BCBS IL billing guidlines for NDC, maybe this will help.


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## rnrray2005 (Apr 18, 2014)

we were also having this problem until we made sure we were using the 5-4-2 numbers


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## cghanbari (Apr 18, 2014)

*problem with bcbs*



Sovacool said:


> Hi All,
> 
> I have a problem with BCBS denying claims because of "Invalid NDCs codes" the problem is they're are valid codes. In the correct 11 digit format straight from the vial. Whenever I called, all I get from the Rep. is " please submit a valid code" I have Encoder and NDC crosswalk and my codes from the vial aren't listed. I double checked with the Rx and they aren't compounded drugs.
> I've tried calling and sending the claims with an invoice with the NDC listed but I'm not successful getting these paid. Anyone have any ideas. I no I legally can't change them to an NDC that's not on the vial but that's what my MD wants. Thoughts?



Hi,
What state are you in.  I am in TX.  I am also having the same problem with BCBS.  Sometimes they say its the ndc and sometimes they say its the format.  We are using a 11 digit only.  I see that people have mentioned the N4 qualifier.  Does anyone know if that is a standard for all commercial insurance and how about for Medicaid and medicare?


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## Sovacool (Apr 18, 2014)

Yes N4 is the prefix requirement for all carriers to my knowledge. I'm in Florida it also only seems to be Florida Blue with the problem not Blue card. I've called them on individual claims and at a provider dispute level to no prevail. In the begin they were paying all the other lines and just not the drugs not it's holding up the entire claim. They are so hard to work with!


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## cghanbari (Apr 18, 2014)

Which drug are you trying to bill


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## cghanbari (Apr 18, 2014)

We are using medisoft.  Is the N4 suppose to go in the box for code id qualifier or is it suppose to go in from of the NDC code.   Is that for all drugs?


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## kmayes (Sep 24, 2014)

I didnt have this problem with BCBS, but now all of a sudden I am.  I call BCBS and I get so many different answers from different reps I am dizzy.  I have gotten:
Make sure to check NDC on Availity
Unit of Measure has to be correct (cant convert MG to GR)
Don't use Availity use the NDC listing that is on every state BCBS website.
We see you used the correct NDC and UoM we dont know why it didnt pay.
Very frustrating as we didnt start having this problem until about 3 weeks ago.
Anyone else having this problem?


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## mbradfo2 (Sep 24, 2014)

We had the same issue for our flu vaccines last spring for BCBS (only sporadically, but usually the same things). They wouldn't,  for example, recognize the new NDC for the current year's Flumist, but would take the -prior- year NDC for flumist (same format/number of digits, etc, just slightly different number since different year/formulation). I'm not sure what's up with their system since the only thing that the rep will say is "invalid" NDC even though it's listed as the valid NDC for the current year's formulation on the CDC and via encoder.


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## Marybeth (Oct 6, 2014)

*Bcbs - ndc#s*

We have a horrible time with BCBS and NDC#'s - If you can get through to pharmacy coding they should be able to give you the #'s that they are looking for.  We submitted information from the FDA and copies of the vials, etc, but to no avail.  We have found that talking to their pharmacy coding department is the only way to get the numbers that they want.


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## rcj0401 (Mar 23, 2021)

So this is an old forum but I am just now having issues with this. Did anyone ever get a resolve? I was given a website to validate NDCs with CPTs but it has a cost of about $17000 a year. I'm employed with a FQHC and that is out of our budget.


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## shanamarie (Mar 23, 2021)

rcj0401 said:


> So this is an old forum but I am just now having issues with this. Did anyone ever get a resolve? I was given a website to validate NDCs with CPTs but it has a cost of about $17000 a year. I'm employed with a FQHC and that is out of our budget.


Have you tried searching the CMS website for the NDC spreadsheets?  I usually find most of my NDC numbers on that document.


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