13 CSR 70-20.340 - National Drug Code Requirement
(1) Drug
charges submitted by providers on an electronic Professional or Institutional
ASC X12 837 Health Care claim transaction or manually entered on a medical or
outpatient claim into the MO HealthNet Division's (MHD) billing website eMOMED
(www.emomed.com) must be billed with
a valid Healthcare Common Procedure Coding System (HCPCS) procedure code and a
valid NDC for all medications administered to MHD participants in the clinic or
outpatient hospital setting. MHD must collect the eleven- (11-) digit NDC on
all outpatient drug claims submitted to MHD from all providers for rebate
purposes to receive federal financial participation. Providers can find the NDC
on the medication's packaging, and must submit the NDC in the five (5) digit -
four (4) digit - two (2) digit format. If the NDC does not appear in the five
(5) digit - four (4) digit - two (2) digit format on the packaging, zero(s) (0)
may be entered in front of the section that does not have the required number
of digits. The MHD denies medical or outpatient claim lines submitted with a
HCPCS procedure code without the corresponding NDC. For medical or outpatient
claims correctly submitted with the appropriate HCPCS procedure code and the
corresponding NDC, the system automatically generates a separate drug claim for
the NDC to process as a pharmacy claim. It will appear as a separate claim on
your Remittance Advice. The MHD will drop the corresponding line with the HCPCS
procedure code and NDC from the medical or outpatient claim. If an NDC is not
provided, the HCPCS procedure code will remain on the claim to report the
denied line. All claims must be billed with the proper NDC quantities, not the
HCPCS quantities. For drugs without a valid HCPCS procedure code, revenue code
0250, "General Classification: Pharmacy," must be used with the appropriate
NDC. Only drugs and items used during outpatient care in the hospital are
covered. MHD does not cover takehome medications and supplies under the
Hospital Program.
Notes
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