Are you using paper claims to bill unlisted procedure codes for drugs and injections?
Providers often file unlisted procedure codes on paper claims in order to include the descriptions of the services rendered. Are you interested in filing your unlisted procedure codes for drugs and injections electronically, but unsure how?
Availity’s electronic format system for filing claims includes a descriptive field for each line of service, allowing you to include the description of services rendered, even for unlisted procedure codes. This helps reduce the unnecessary filing of paper claims.
In the past, services for not-otherwise-classified (NOC) “J Codes” required narrative descriptions and/or submission using paper claims. The fields below provide the additional information required by the Blue Cross and Blue Shield of Texas (BCBSTX) adjudication system to process these services electronically. The addition of these fields will expedite processing and ensure accuracy. The following table defines the new fields and the location of the elements in the professional electronic claim format.
Field name |
Field description |
ANSI (loop 2410) |
NDC UNITS |
National Drug Code Units. This field identifies the number of units administered of the prescription drug. |
CTP04 |
NDC UNIT OF MEASURE |
National Drug Code Unit of Measure. This field identifies the unit of measure of the drug administered. Values: |
CTP05-I |
NATIONAL DRUG CODE |
National Drug Code. National code assigned to the drug administered. |
LIN02 = “N4” |
NDC UNIT PRICE |
Unit Price. Price per unit of measure for the administered drug. |
CTP03 |
The NDC number is sent on an electronic ANSI 837 ANSI (4010A1) in the LIN segment of the 2410 loop. The LIN 02 houses the qualifier and the LIN03 houses the actual descriptive field. The 2410 loop is a situational loop that may not always appear on the electronic 837 claim file. The loop is included only if the billing party has to report drug information.
You may need to modify provider billing systems or notify billing vendors of these changes. Please contact your software vendor to ensure your software will support these data elements. If you have any questions, contact Availity Client Services at 800-AVAILITY (800-282-4548).