Requirements for Provider-Administered Drug Reimbusement. All outpatient medical claims for provider-administered drugs must contain a Healthcare Common Procedure Coding System (HCPCS) code, a National Drug Codes (NDC) number, the NDC unit of measure, and the NDC quantity. The MCO must edit claims using the West Virginia’s NDC to HCPCS Crosswalk file provided to the MCO monthly. The MCO must deny the claim line item, if such a claim is missing the NDC information, or the NDC is not valid for the corresponding HCPCS code, as the drug is not considered a covered Medicaid benefit. This requirement applies to Medicare cross-over claims in addition to the other claims where a third party paid a portion of the claim.
Appears in 5 contracts
Samples: Model Purchase of Service Provider Agreement, Service Provider Agreement, Model Purchase of Service Provider Agreement
