The Deficit Reduction Act of 2005 includes provisions about the state collection of data for the purpose of collecting Medicaid drug rebates from drug manufacturers for physician-administered drugs. Since there are often several NDCs linked to a single HCPCS code, the Centers for Medicare & Medicaid Services (CMS) deems that the use of NDC numbers is critical to correctly identify the drug and manufacturer in order to invoice and collect the rebates.

Due to the above requirement, PacificSource Medicare will begin sending claims back to providers because it is either missing the required NDC information or the NDC information billed is incomplete or invalid. If the claims are submitted via a clearinghouse, we will reject the claims back to them. If the claims are mailed into us, we will send the claim directly back to the provider. 

Providers will need to resubmit the claim with the correct NDC information for processing.

If you have any questions on the above information, please feel free to contact your Provider Service Representative.