Requirements for National Drug Codes Submission for Physician Administered Drugs

Blue Shield of California Promise Health Plan requires claims and encounters reporting Physician Administered Drugs (PADs) to include both the Healthcare Common Procedure Coding System (HCPCS) code and a valid National Drug Code (NDC) for Medi-Cal and Cal Medi-Connect members.

The Department of Health Care Services (DHCS) began enforcing this requirement effective July 1, 2019.

The requirements for 837P and 837I submissions are as follows:

  • If the procedure code reported in 837P 2400/101-02 or 837I 2400/202-01 is listed in the HCPCS code list (PDF, 448 KB), then the following drug information must be populated:
     
    837 LOOP/SEGMENT EXPECTED VALUE
    2410/LIN02 N4
    2410/LIN03 NDC
    2410/CTP04 Drug quantity
    2410/CTP05-1 Drug measurement code
    2410/REF Required, if involved the compounding of two or more drugs
 
  • NDC must be a valid code that corresponds with Food and Drug Administration (FDA) NDC
  • NDC must be 11 numeric digits, all zeroes will not be accepted

 

The current HCPCS code list is distributed by DHCS. Each HCPCS code in the list must be accompanied by a valid NDC.

Blue Shield Promise Health Plan will deny claims that do not meet these requirements. All claims denied by Blue Shield Promise must be corrected and resubmitted.

Identified Claims and Encounters submitted prior to October 1, 2019 that do not meet these requirements need your attention. These claims and encounters must be corrected and resubmitted.

If you have any questions on how to submit this information electronically, please contact EDI Platform Services:

 Phone: (800) 480-1221

 Email: EDI_PHP@blueshieldca.com

DHCS HCPS code list

Review the list of procedures requiring additional drug information.                          

 

EDI companion guides

Access our companion guides for trading partners who exchange electronic transactions directly with us.

Local code encounter crosswalk

Find the national codes that must replace local billing codes. For billing claims, Blue Shield Promise continues to utilize Medi-Cal local codes following the Medi-Cal Fee-for-Service Program's phased approach to convert the interim (local) codes to national values.


 

Provider Connection

Access network provider tools on Provider Connection website.

Health Care Options: (844) 580-7272  {TTY: {800) 430-7077}, Monday through Friday from 8 a.m. — 6 p.m. 

For information on Blue Shield Promise plans for your health care, call the Department of Health Care Services at (800) 430-4263 {TTY: (800) 735-2922}, or visit https://www.healthcareoptions.dhcs.ca.gov/.

Blue Shield of California Promise Health Plan is a managed care organization, wholly owned by Blue Shield of California, offering Medi-Cal Plans.

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California Physicians’ Service DBA Blue Shield of California Promise Health Plan is an independent licensee of the Blue Shield Association.

The provider network may change at any time. You will receive notice when necessary.

Blue Shield of California Promise Health Plan complies with applicable state laws and federal civil rights laws, and does not discriminate on the basis of race, color, national origin, ancestry, religion, sex, marital status, gender, gender identity, sexual orientation, age, or disability.

Blue Shield of California Promise Health Plan cumple con las leyes estatales y las leyes federales de derechos civiles vigentes, y no discrimina por motivos de raza, color, país de origen, ascedencial, religión, sexo, estado civil, genero, identidad de genero, orientación sexual, edad ni discapacidad.

Blue Shield of California Promise Health Plan 遵循適用的州法律和聯邦公民權利法律,並且不以種族、膚色、原國籍、血統、宗教、性別、婚姻 狀況、性別認同、性取向、年齡或殘障為由而進行歧視。

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Blue Shield of California Promise Health Plan, 3840 Kilroy Airport Way, 
Long Beach, CA  90806

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