RFI Browser

Back  RFI # 616: 835 reporting J-codes and NDC

Formal vs. Informal Help Informal Formal

Submitter

Lori Andersen

Description

We are now capturing J-codes and NDCs from incoming claims for the purpose of collecting Medicaid drug rebates. We would like to report back the submitted J-code and the NDC on the 835. Is there a place on the 835 to accommodate the submitted procedure code and the NDC?

Submitter Assigned Keywords

835 NDC J-code drug rebate

Response

This issue is explicitly addressed in guide 004010X091. The SVC segment supports reporting of:
1 - One adjudicated procedure code (which can be a HCPCS code, Dental code, Revenue or an NDC code) in SVC01
2 - The submitted procedure code, when different than the adjudicated code, (which can be a HCPCS code, Dental code, Revenue code or NDC code) in SVC06

There is no way to report back both a HCPCS and NDC code as either the adjudicated or submitted procedure code.

If a claim is submitted with a J code in the SV1 or SV2 and an NDC in the LIN segment:
IF Adjudicated code=J-code then SVC01=J-code and SVC06 = empty
IF adjudicated code=NDC then SVC01=NDC and SVC06=J-code

Recommendation

Submission 12/11/2007
Status Date 3/11/2008
Status F - Final
Primary References
Document 004010X091A1
Section2110 SVC
Page142
Set ID835
Loop2110