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Help for Injectable Drug Claims  (Article 3)

The next time you file a claim form after giving a TRICARE beneficiary a vaccine or immunization (or other injectable), remember to include the National Drug Code (NDC) as well as the Level II Healthcare Common Procedure Coding System (HCPCS)
J-code.
 

The 11-digit NDC number, drug quantity and package unit (P/U) indicators are necessary on all of your injectables claims filings in order to ensure accurate pricing and payment for all injectables. This information is required in addition to the HCPCS/Current Procedural Terminology (CPT) drug code and quantity, which can be different than the NDC drug quantity.
 

If you’re a network or a non-network provider filing electronic claims, the following instructions provide the loops or segments where you should send J-codes and NDC numbers in the Health Insurance Portability and Accountability Act (HIPAA)-standard ASC X12 837P electronic claims format:
 
  • 2400/SV101 = J-code
  • 2400/SV103 = “UN” (unit) for Package, or “F2” (International unit) for Unit
  • 2410/LIN03 = NDC number (11 digits with no dashes or spaces)

If you are a non-network provider filing a CMS-1500 paper claim, use the shaded area above each line in the “Lines” field to enter the additional information. Some things to remember:
 
  • Make sure the NDC number is listed above the J-code.
  • Enter the NDC number without using spaces or dashes.
  • Some NDC numbers have a package or unit price, so ake sure to put a “P” or a “U” after the NDC number, if necessary.

Where a HCPCS code is entered on the CMS-1500, the units should match the HCPCS units. In the box above the HCPCS box, you can enter the following NDC information: NDC number, a slash and either a “U” or “P” (for unit or package), a slash and the drug units corresponding to the NDC. For example, the drug unit may be “one vial,” but the HCPCS unit may be “250mg.”
 

Specialty Suppliers
For TRICARE providers in the South Region, Humana Military offers specialty pharmacy services where providers
in the region can order their specialty drugs. The two specialty pharmacies are:
 
  • CuraScripts—for Synagis (immune globulin) only
  • PrecisionRx—for all other specialty drugs
Two of the benefits of using these specialty pharmacies are that they will deliver directly to your office and, because they are network providers, they bill directly to PGBA, which eliminates the provider’s billing paperwork for specialty drugs.

  
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Created: August 6, 2007