Submitting Claims for Injectable Drugs

 
Medicare and Medicaid require providers who furnish and dispense injectable drugs to include the most
relevant National Drug Code (NDC) number on the claims whether they are submitted on paper or electronically. TRICARE conforms with the Centers for Medicare and Medicaid (CMS) requirements by ensuring the same billing for drug-related services is applied to all claims submitted on paper or electronically. The required NDC number (usually 11 digits) is located on the label or invoice sheet from the medication supplier. Providers must also include the quantity, the package/unit amount and dose dispensed when submitting the claim. This information is vital to ensuring the provider is reimbursed correctly.
 
Injectable drugs sometimes have several NDC numbers assigned, all with varying package/unit prices and suggested dosages. The drug description may also include a suggested dosage by age or frequency. However, the claim will be determined by the calculation of the drug reimbursement by the NDC and the correlating package/unit dispensing amount provided by your office. Humana Military Healthcare Services, Inc. (Humana Military) makes every effort to complete claims for adjudication, even when information is missing. Humana Military may reject claims with missing information and request that your office resubmit.
 
For more information about billing drug-related services, refer to the TRICARE Reimbursement Manual, which is available at www.tricare.mil.