Medicaid Claims Rejections

Posted by on November 10, 2011 in Health Care, Health Care Interfaces, Interface Standards | 0 comments

Medicaid decided to start rejecting some electronic claims because there were too many NDC codes on the claim. Now I’m not a rocket scientist, but shouldn’t a claims processor be able to handle more than 1 NDC code per claim?

They’re stating that if more than 1 NDC is present, it’s treated like a compound drug, which shouldn’t be an issue either because compound drugs have their own NDC’s. Therefore you must bill vaccines with NDC codes on separate claims. If a child got 4 vaccines during the visit, 4 separate claims with the same date of service should be sent, with only 1 vaccine and associated admin fees per claim.

This is just another example of why standards need to be followed instead of looked at as starting guidelines. This type of behavoir increasing cost in the healthcare system.

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