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Some BCCHP and MMAI Claims May Need to be Resubmitted

Posted May 11, 2018

Blue Cross Community Health PlansSM (BCCHPSM) and Blue Cross Community MMAI (Medicare-Medicaid Plan)SM has completed its conversion for National Drug Code (NDC) validation to the Medi-Span platform. This change places BCCHP and MMAI in compliance with Healthcare and Family Services (HFS) requirements for pre-edit validation. Medi-Span contains all NDCs with valid date spans and is approved by HFS.  

Providers may have had previous claims with valid NDCs erroneously rejected at the clearinghouse level indicating an invalid NDC was submitted. Claims impacted by the rejections can be submitted as follows:

  • For claims submitted between Jan. 1, 2018, and Feb. 19, 2018, (implementation of the NDC Database): No action is required. Claims for these submission dates are able to be systematically reprocessed. Reprocessing of claims submitted during this time will be reprocessed by May 15, 2018.
    • Only claims with NDCs which were valid on the date of service will reprocess. Claims with NDCs that were invalid on the date of service will not reprocess.
  • For claims submitted between April 1, 2016, and Dec. 31, 2017, with valid NDCs for the dates of service being billed must be resubmitted for claim reconsideration. Timely filing considerations will only be waived for claims requiring a NDC that was rejected during the original submission window listed above.
    • All claims impacted by this issue must be resubmitted by June 15, 2018.