February 20, 2013
All Blue Cross and Blue Shield of Kansas Contracting ProvidersFrom:
Connie Winkley – Education/Communication Coordinator
Institutional Provider Relations
Blue Cross and Blue Shield of Kansas, Inc.
An Independent Licensee of the Blue Cross and Blue Shield Association
National Drug Code (NDC) format change due to HIPAA 5010
This newsletter provides information on the HIPAA 5010 standard NDC format which requires 11 digits, even though the FDA only assigns 10 digits. A leading 0 must be added to the appropriate segment to bring the total digits to 11. There are three segments; the first segment identifies who packaged the product and will have 4 or 5 digits, the second segment identifies the drug and will have 3 or 4 digits and the third segment represents the package size and will have 1 or 2 digits. A leading zero must be added to the appropriate segment to bring it to the 5-4-2 HIPAA format.
Below are examples to assist with the formatting of the NDC:
Another issue with the NDC that providers may be experiencing is not having an NDC on file with Medispan or First Data Bank (FDB). For example, a product is packaged for sale in a carton of 10 with the required package insert. This package of 10 would have an NDC on file because that is how the drug is available for purchase. The NDC on the carton of 10 might be 55555-4444-11, for example. This is the NDC that should be used. However, each of the individual vials in the package might have an NDC of 55555-4444-10; there is no consistency for the package size details. If this drug is not available for purchase as a package of one, NDC 55555-4444-10 will not be in the drug data base and would be denied. For this example, the NDC on the carton is the one that must be submitted.
If you have questions regarding this newsletter, please contact your BCBSKS Provider Representative.