06/06/2018

United Healthcare

Important Updates

 Addition to National Drug Code Requirement Policy

For claims with a date of service on or after Sept. 1, 2018, there will be an addition to the National Drug Code (NDC) Requirement reimbursement policy to include drug-related codes submitted on the CMS-UB04 and Electronic Data Interface (EDI) transaction 837i. Outpatient claims submitted for reimbursement for drug-related Healthcare Common Procedure Coding System (HCPCS) and CPT codes for UnitedHealthcare commercial and UnitedHealthcare Medicare Advantage members must include the NDC number, quantity and the unit of measure. If the required NDC information is not included, the claim may be denied and you will be notified through a Provider Remittance Advice (PRA) to resubmit the claim with the NDC information.

For UnitedHealthcare commercial claims, this requirement will apply to claims submitted on CMS 1500, 837p, CMSUB04 and 837i claim forms for drug-related HCPCS/CPT codes. The policy will no longer require the NDC information for child and adult immunization drug codes.

For UnitedHealthcare Medicare Advantage claims, this change will only apply to outpatient facility UB04 claims submitting unlisted drug-related HCPCS/CPT codes. The current policy requiring the NDC information for drug-related HCPCS/CPT codes submitted on the CMS 1500 and 837p will remain in effect. The policy will no longer require the NDC information for child and adult immunization drug codes.

Specialty Medication Administration - Site of Care Review Guidelines

FOR MORE INFORMATION AND TO READ THIS BULLETIN: CLICK HERE