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
DHCS HCPS code list
Review the list of procedures requiring additional drug information.
If you have questions on electronic claim submissions or EDI 837/835 files, submit an online EDI inquiry.
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.
Access network provider tools on Provider Connection website.