Updated 02/07/2012: New NDC Claims Requirements

UPDATE 02/07/2012: We are now transmitting all the necessary fields to include NDC information on all claims being sent through the standard professional format. Please disregard any instructions recommending the use of the legacy format.

Claims containing NDC information must be sent from your system in the 4010 (Legacy) format. We are currently working to make sure claims sent in the 5010 (Standard) format contain the correct NDC information. Some carriers are requiring 5010 (Standard) format claims and RelayHealth will convert the 4010 (Legacy) claims you send to a 5010 (Standard) claim for those carriers. In 4010 (Legacy) claims the Drug Pricing/CTP04 segment was optional. In 5010 (Standard) claims it is required. This would be the NDC Quantity field entered during Charge Entry and the NDC Unit Price field completed in the Charge Codes Master Files.

Follow these steps to ensure that claims needing NDC information do not get rejected:

Enable Advanced NDC Fields

1. Go to Utilities | Sytem Defaults | Claims
2. Set Use Advanced NDC Fields to Yes.
3. Click Save.


Update Charge Codes Master Files

1. Go to Master Files | Transaction Codes | Charge Codes.
2. Select the Charge Code you wish to enter NDC information for.
3. Enter information into the NDC Code, Description, NDC Unit Price and Unit of Measure fields.
4. Click Save.

Enter the NDC Quantity during Charge Entry

1. Select Patient through Transaction Entry or Quick Charge Entry.
2. Complete all required fields and enter the NDC Quantity field.
3. Click OK (Transaction Entry) or Process (Quick Charge Entry).

**The NDC Quantity must be entered during Charge Entry. This field cannot be modified after the charge has been posted. If you need to modify previously entered charge, you will need to void and repost those charges.

 

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