Anthem requires National Drug Code for outpatient claims effective January 1, 2020

January 06, 2020
Area(s) of Interest: Practice Management Drug Prescribing/Dispensing 

Effective January 1, 2020, Anthem Blue Cross has imposed a new billing requirement on providers for all drug related claims, except those administered in an inpatient facility setting. Claims must now include all of the following information:

  1. Applicable HCPCS code or CPT code
  2. Number of HCPCS code or CPT code units
  3. Valid 11-digit National Drug Code(s) (NDC), including the N4 qualifier
  4. Unit of Measurement qualifier (F2, GR, ML, UN, MG)
  5. NDC units dispensed (must be greater than 0)

Anthem will deny any line items on claims regarding drugs that do not include the above information for dates of service on or after January 1, 2020. The policy change was originally outlined in a September 27, 2019, letter to providers and highlighted in the January 2020 Anthem Blue Cross California Provider Newsletter.

Providers with questions regarding the new requirement or policy should contact Anthem Provider Services at (800) 677-6669 or CAcontractsupport@anthem.com.

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