| NEW Availity Professional Claim Edit - August 2009 |
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Recent electronic claim processing enhancements for providers utilizing the Availity gateway include implementation of an edit to validate the National Drug Code (NDC) upon receipt of all professional (837 P) claim transactions.*
The NDC for drugs administered by professional providers must be included in conjunction with the applicable Healthcare Common Procedure Coding System (HCPCS) procedure code(s) when billing for "Not Otherwise Classified" (NOC), or "J Code" drugs.
To be considered valid,
- 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, number of units, unit of measure and price per unit also must be included, as indicated in the table below.
Professional electronic claims submitted with an invalid or inactive NDC will be rejected. Modifications to provider billing systems or notification to billing vendors to accommodate changes may be necessary.
Field Name |
Field Description |
ANSI (Loop 2410) - Ref Desc |
Product ID Qualifier |
Enter "N4" in this field. |
LIN02 |
National Drug CD |
Enter the 11-digit NDC (without hyphens) assigned to the drug administered. |
LIN03 |
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Drug Unit Price |
Enter the price per unit of the product, service, commodity, etc. |
CTP03 |
NDC Units |
Enter the quantity (number of units) for the prescription drug. |
CTP04 |
NDC Unit / MEAS |
Enter the unit of measure of the prescription drug given. (Values: FR
- international unit; GR - gram; ML - milliliter; UN - unit) |
CTP05-1 |
If you have any questions regarding utilization of the NDC code in your electronic claims, please contact our Electronic Commerce Center at (800) 746-4614.
*Additional functionality for facility (837 I) claims may be added at a later date.
Availity is a registered trademark of Availity, L.L.C., an independent, third party vendor.
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