Effective 1 de julho, 2022, BCBSRI will require the National Drug Code (NDC) to be filed on all claims submitted with a drug HCPC/CPT code. When filing an NDC # on your claim, it must be in an 11-digit format. Failure to provide the NDC # on your claim or not provide the entire 11-digit code will result in your entire claim being denied or being removed from the system at your clearing house.

If a paper claim is filed to BCBSRI with no NDC # on the claim – BCBSRI will accept the claim, however the entire claim will be denied on your provider RA with a denial reason code which reads: “x56 The National Drug Code is required when filing with a Drug HCPC/CPT Code."

If a paper claim is filed to BCBSRI with an NDC # that is not valid (e.g., 10 digits instead of 11) – Your entire claim will be rejected, and a letter will be sent to you indicating the NDC # was invalid on your claim.

If your claim is filed through electronic submission with no NDC # on the claim – Your entire claim will be rejected from your clearing house with a rejection code of “LINE PROC CD REQUIRES NDC."

If your claim is filed through electronic submission with an invalid NDC # – Your entire claim will be rejected from your clearing house with a rejection code of “L326 - NDC Missing or Invalid."

If a BCBSRI participating provider/facility is filing a claim for an out of area member, the NDC is required on the claim in order for your claim to be reimbursed for the services. If a BCBSRI member sees an out of area provider, the NDC is not required for that out of area provider, but we will accept the NDC if it is on the claim.

A valid NDC code will be required for coordination of benefits claims where BCBSRI is the secondary carrier. If the primary carrier does not require the NDC, you will need to provide the NDC code on your secondary claim submission for your entire claim to be paid.

If you have any questions regarding this requirement, please contact Provider Relations at ProviderRelations@bcbsri.org.

For reference: Payment Policy – Coding and Claim Filing Requirements for Drugs