New BlueSalud provider requirements for billing supplies       
Effective January 1, 2012, professional providers, outpatient hospit
al providers, and medical supply companies will be required to include the National Drug Code (NDC) when billing certain supply items. BlueSalud providers must now include the appropriate NDC and other essential information when billing for drug items, certain supply items to medical supply providers, and IV infusion providers when billing on the CMS-1500 claim form. Providers may need to contact their software vendors to modify billing software.

Physician and hospital providers were first notified by the Human Services Department/Medical Assistance Division (HSD/MAD) in November 2007, in
HSD Supplement 07-09. These providers were again notified in May 2010 of the requirement in HSD Supplement 10-03. Providers were notified of the new requirements in November 2011 in HSD Supplement 11-08.

The new billing requirement adds the following HCPCS or CPT® codes:

  • A4216–A4218, A4246–A4248 (miscellaneous supplies)
  • A4641–A4642 (supplies for radiologic procedures)
  • A9150–A9153, A9500–A9501, A9505–A9507, A9535–A9536, A9600–A9700 (administrative, miscellaneous, and investigational supplies)
  • C9113–C9279 and C9399 (miscellaneous)
  • J0120–J9999 (carious injections and chemotherapy)
  • P9023, P9041, P9043–P9048, P9059–P9060 (miscellaneous tests)
  • Q0138–Q0144, Q0163–Q0181 and Q0515, Q2004, Q2009, Q2017, Q3025–Q3026 (miscellaneous)
  • S0012–S0197, S4990–S5001, S5010–S5014 (various items)
  • S5550–S5571 (insulin injections)
  • 90281–90399 (immune globulins)

Refer to the HSD Supplements above for codes previously listed in the requirements.

Note: A provider paid on the basis of an encounter rate such as a federally qualified health center, an Indian Health Service or tribal compact facility, or a bundled rate such as drugs included in a dialysis cap charge does not need to supply an NDC code because he or she is not reimbursed using one of the above codes.

Claims billed without the NDC codes listed above will be denied beginning January 1, 2012.

NDC submission reminders

  • Submit the NDC along with applicable HCPCS or CPT procedure code(s).
  • The NDC must be in the proper format (11 numeric characters, no spaces or special characters).
  • The NDC must be active for the date of service.
  • The appropriate qualifier, unit of measure, number of units, and price per unit also must be included, as indicated below.

Electronic claim guidelines

Field NameField DescriptionANSI (Loop 2410) Reference Description
Product ID QualifierEnter N4 in this fieldLIN02
National Drug CodeEnter the 11-digit NDC (without hyphens) assigned to the drug administeredLIN03
Drug Unit PriceEnter the price per unit of the product, service, or commodityCTP03
NDCEnter the quantity (number of units) for the drugCTP04
MDC Unit/MEASEnter the unit of measure of the prescription drug given (values: F2=international unit; GR=gram; ML=milliliter; UN=unit)CTP05-1

837 transactions
You should notify your billing or software vendor that the NDC code must be reported in the following fields in the 837 format:

  • Loop 2410
  • Segment LIN
  • Field LIN02: Use the qualifier “N4”
  • Field LIN03: Place the 11-digit NDC here

If you have any questions about using the NDC code on your electronic claims, contact our Electronic Commerce Center at 800-746-4614.
 

Blue Review • January 2012 • bcbsnm.com