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The NDC must be entered with 11 digits in a 5-4-2 digit format. The first five digits of the NDC are the manufacturer’s labeler code, the middle four digits are the product code, and the last two digits are the package size.
- Billing and Claims Quick Reference Guide
Resources. Note: Aetna Better Health® Kids incorporates the...
- Billing and Claims Quick Reference Guide
Resources. Note: Aetna Better Health® Kids incorporates the National Correct Coding Initiative (NCCI) edits into its claims policy and procedures as announced by PA DHS MAB 99-11-10. control improper coding leading to improper payment in outpatient claims. NCCI has two compone.
National Drug Code (NDC) Validation Requirements. What should you know? Federal laws allow Aetna Better Health of Pennsylvania to pay for drugs only from drug manufacturers or labelers who are part of the Medicaid Drug Rebate Program including those drugs dispensed to our members.
28 Σεπ 2023 · The healthcare system and payors currently convert 10-digit NDCs to 11-digit NDCs, which increases healthcare costs and may be a factor in medication errors.
*FOR BEHAVIORAL HEALTH ACCESS STANDARDS: unless state requirements are more stringent. *FOR AETNA MEDICARE ADVANTAGE PLANS: Plans must comply with CMS requirements and time frames when processing appeals and grievances received from Aetna Medicare Advantage plan members. Refer to the . Medicare
NDCs may appear in a 10-digit FDA standard format on the drug’s labeling. When this occurs, you must pad any shortened segment(s) a leading zero so they comply with the 5-4-2 format. Use the table below to determine how to appropriately pad a 10-digit NDC to create an 11-digit code. Convert NDC from 10 Digits to 11 Digits 10-digit Format Segments
(NDC)- Expired NDC Numbers-According to CMS policy, providers are required to report valid National Drug Code (NDC) numbers for the given date of service. Therefore, when an NDC number has been designated as expired it is only allowed to be reported for the “obsolete” period of 30 months (913 days) set in the standard NDC reference sources.
