Wiki J9190

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LisaAnn

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Local Chapter Officer
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20
Location
Blythe, Georgia
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Is anyone out there having an issue getting this drug to pay. The problem I am finding is Georgia Medicaid doesn't want to pay the drug with the NDC code I am using. The NDC code is directly off the medication bottle from the manufacture. Any ideas? I am relatively new to Hem/onc billing and coding

thanks
 
Are you using the N4 qualifier with no space before the NDC number? Is the number going into the shaded space abover the J9190 and not box 19?
 
yes, and i have double checked the NDC code. I have even hand keyed it on the denied claim and tried to resubmit it. It is very frustrating.
 
the only other thing I can think of then is are there 11 digits in you NDC # (13 characters total with the N4 qualifier added)? and again just double check where your software is putting the number and be sure it is not box 19.
 
We are having the same problem with our local Medicaid. The problem is that they do not have all the possible NDCs loaded in their claim computer. We have been told it will take 6 months to add them. In the meantime we have to appeal to our state HHSC.
 
We have discovered that more often than not the NDC# on the bottle/vial would be different if you compare it to the NDC# on the box the bottles/vial come in. NC Medicaid might deny a reimbursement on the drug with the NDC# off the vial but would have no problem reimbursing when we re-file the drug with the NDC# indicated on the bottle.

Best regards-
 
thank you for the web link. Coming from a radiology background learning NDC and billing procedures for Hem/Onc has been different.
 
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