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NDC and Claim Adjustments

March 27, 2013

CareOregon wants you to be aware of potential claims adjustments and recovery efforts in regards to NDC related claims paid in error.

DMAP has informed CareOregon that the CMS Cross Walk, Noridian Cross Walk and the Drug Product Data list do not contain effective and term dates for the NDC numbers. Because we have been using these sites to process NDC claims, CareOregon has paid for many drugs with invalid or termed NDC codes, according to DMAP. To meet DMAP’s requirements, we will be adjusting 9,000 to 10,000 claims.

DMAP uses data from a vendor, First Databank Drug Data, for NDC verification. Because all entities may not have access to First Databank, DMAP has suggested using the U.S. Food and Drug Administration ’s (FDA) NDC link, included below, for NDC verification.

Effective immediately, CareOregon will be using the FDA NDC link to process claims. This will increase the number of claim line items denied for invalid or termed NDC codes. Please verify that the codes you are billing are the current NDC codes and that they are effective on the date of service of your claim.

If you have any questions, please contact Customer Service, or your provider representative, 503-416-4100 or 1-800-224-4840, 8:00am to 5:00pm, Monday through Friday.