REJECTION OF WHOLE CLAIMS WITH J CODES FOR NDC# UPDATE

cpt code - j7613, j7609
DESCRIPTION OF THE ISSUE
Claims filed without or incorrect NDC#s, MCD HMO carriers (Staywell/Health Ease) rejected entire claim for NDC# updates, instead of processing denial only for J Codes.

CONCEPT
All injection drug codes should be billed along with NDC# updates for the claims to be reimbursed.

SOLUTION
Carriers’ database setup has been modified to reject the entire claim when filed with J Code without/Incorrect NDC#s, instead of processing denial only for the J Code.  So we segregated J code as a separate claim.  This enhanced payment for rest of the CPTs and the J code alone was denied for need of NDC#.

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