Medicaid claims missing NDC numbers: Claim rejections and recouping past payments

For all Medicaid claims (billed on a CMS 1500 or UB-04 claim form) billing a drug/pharmaceutical code, we require that the specific National Drug Code (NDC) be included on the claim. Including the NDC on the claim has been a requirement from Medicaid that we began enforcing in 2016.

Effective immediately, any Medicaid claim billed without an NDC number will automatically reject with reason code "NDC missing or invalid."

We are recouping 2017 payments

Any Medicaid claim with a drug charge missing an NDC number that was paid within the past year will be recouped, and providers are encouraged to rebill those claims with the proper NDC number(s).  

Questions?

See our provider information on billing Medicaid drug claims with NDC numbers, and how to format those numbers, under Billing & payment > NDC numbers on drug claims.