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Marcus,
No we
don't have a formal document, though we are in discussed with EDS very regularly
to try and understand. We are implementing in Indiana from both a provider
and a payer side, as well as Medicaid HMO... so we really need to know... as you
all do. We will all just have to keep after it. EDS, if you
are out there on this list, please respond. Thanks!
Miriam,
Supposedly the state of Indiana has decided to require the NDC so that they could collect rebate dollars
for drugs being billed. I found out about the
"Indiana requirement" last week and it appears that Illinois Medicaid also has
NDC requirements. I have called/e-mailed Indiana EDS for a definitive
source for the NDC requirement for the 837 transactions because their draft
companion guides still list the 2410 segments as situational, but am not
receiving any response. Do you have a formal document that lists the
requirement?
I have also asked EDS how/where they expect to
see this data on hard copy claims should that be necessary.
Marcus E. McCrory
The Cirius Group,
Inc.
(925) 685-9300 (tel)
(925) 685-6526 (fax)
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----- Original Message -----
Sent: Friday, August 08, 2003 9:39
AM
Subject: RE: NDC Codes - Medicare vs.
Medicaid
Miriam, I have not heard of a similar requirement for Alabama
Medicaid. The state has converted local codes to use J codes. The
way I understand the implementation guide is that NDC is only used
"when required by government regulation" or "as deemed appropriate by the
provider to enhance reporting/adjudication processes". So, IMO, unless
Indiana or any other state has a regulation to require use of the NDC, the
facility should not have to report NDC unless it chooses
to.
John Craft
Partner, HCS
866-271-1359
In a recent provider workshop conducted in
Indiana by AdminaStar Federal (Medicare FI), the following issue came
up.
The representative for AdminaStar
Federal confirmed that Medicare will not require NDC
codes for drugs (i.e., "J" codes will work). She went on to say that
Medicaid, however, says it will require NDC
codes. Members
of the hospital's
billing staff were told at a
Medicaid workshop (held during the week before) that because
the new claim field isn't big enough to contain the entire NDC code, the
last couple of digits of the NDC code should be placed in another
field. A related question involves how "cross over" claims will be
handled between Medicare and Medicaid when NDC codes are
involved.
Are the rest of you
running into this in other
states?
Best
Regards,
Miriam J. Paramore
President & CEO
Co-Founder and President
PCI: e-commerce for healthcare
HAWK - HIPAA Action Workgroup of Kentucky
9001 Shelbyville
Road
www.hawkonline.org
iTRC Building
Louisville, KY 40222
ph
502-429-8555 fax
502-852-4701
www.hipaasurvival.com
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