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GA Medicaid and NDC issues
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Re: GA Medicaid and NDC issues
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Doo
Re: GA Medicaid and NDC issues
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Aug 10 07 10:12 AM
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EUREKA! I think I've found it! From:
/www.ghp.georgia.gov/wps/...rsswlk.pdf
. This bulletin is 5/17/07.
Why are my claims continuing to deny against edit 1574NDC Procedure Code Mismatch?
The system may not be recognizing the HCPCS/CPT NDC combination reported/billed as valid. Invalid HCPCS/CPT NDC combinations may be related to billing errors or crosswalk file set-up, i.e., the HCPCS code or NDC number may be a) incorrect, b) entered in the wrong field, c) missing the preceding N4 qualifier (where applicable), or d) not included on the NDC Crosswalk file. To determine if the claim denial is related to a correctable billing error or crosswalk file set-up, it is important to trouble shoot the issue:
Trouble Shooting Tips:
1. Verify the drug is covered by Georgia Medicaidrefer to the Physician Injectable Drug List at
www.ghp.georgia.gov
.
2. Check the HCPCS/CPT code to ensure it is valid, an approved code, and is being reported in a 5-digit alpha-numerical format
3. Check the NDC number to ensure it is being reported in an 11-digit numerical format. For NDC numbers with less than 11-digits, add 0 where indicated (refer to previous banner instructions).
4. Verify the N-4 qualifier is being reported with the NDC number on paper and X-14 electronically submitted claims only (refer to previous banner instructions)
5. Contact the Provider Inquiry Unit at (404) 298-1228 or toll free at (800) 766-4456 to verify the HCPCS code is on the crosswalk file.
If found to have been billing errors, correct and resubmit the claim.
If the response to all of the above is yes, it is possible the HCPCS/CPT NDC combination not be listed on the walk file. If the drug is already on the crosswalk file under a different HCPC/CPT code, the second HCPCS/CPT code cannot be added or processed. Namely because the crosswalk file entry process does not allow for more than one HCPCS/CPT code for the same drug to be mapped to the NDC numberresulting in claim denials.
For example, if CPT 90645 (HIB Vac, HBOC, IM) is already listed and mapped to NDC # 54569-5269-00CPT 90647 (HIB Vac, PRP-OMP) cannot be added as it also maps to NDC 54569-5269-00. Other examples include but are not limited to:
a. 90633 (Hep A Vac, Ped/Adol, 2 dose) and 90634 (Hep A Vac Ped/Adol, 3 dose)share NDC 00006-4831-00
b. J0885 (Epoetin Alfa, 1000 units (for non-ESRD use)) and J0886 (Epoetin Alfa, 1000 units (for ESRD on dialysis)) share NDC 55513-0148-10
Sharon
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Association News
Medical Billing & Coding Education from the MAB
Continuing Education
Management Advice and Training
Questions Asked More Than Once
Help Wanted - Billing and Coding
Non Billing Talk
The Venting Area (Clean posts please)
Medical Coding and Billing News
Fraud and Abuse
Health Insurance - Provider Contracting
ERISA
Tricare
Workers' Compensation
General Medical Billing Questions
Appeals
Accounts Receivables (A/R)
Refunds
Auto Accident Issues
Medisoft Technical Support
Medical Software Technical Support Questions Other than Medisoft. No Investigation Questions!
General Medical Coding Forum
CPT Coding Questions
HCPCS Coding Questions
ICD-9-CM Coding Questions
Evaluation & Management Coding Questions
Acupuncture Billing and Coding
Ambulance Coding and Billing
Cardiology Coding and Billing
Chiropractic Coding and Billing
Dental Billing and Coding
DME Coding and Billing
Emergency Department Coding and Billing
Family Practice Coding and Billing
Hospital Inpatient and Outpatient Coding
Hospital Billing, Appeals and Collections
Internal Medicine Coding and Billing
Laboratory Coding and Billing
Ophthalmology Coding and Billing
OB-GYN Coding and Billing
Pain Management Coding and Billing
Pediatric Coding and Billing
Podiatry Coding and Billing
Physical Therapy Coding and Billing
Psychiatry Coding and Billing
Radiology Coding and Billing
Surgery Coding and Billing
Neurology Coding and Billing
Urgent Care Coding and Billing
Provider Compliance
Billing Center Compliance
HIPAA
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