Standard UnitedHealthcare Claims Submission Process for National Drug Codes for UnitedHealthcare Commercial & UnitedHealthcare Medicare Advantage Professional Claims, Effective Jan. 1, 2017
For dates of service on or after Jan. 1, 2017, we will begin enforcing the UnitedHealthcare Physician, Health Care Professional, Facility and Ancillary Provider Administrative Guide for Commercial and Medicare Advantage Products national drug code (NDC) requirement, which requires UnitedHealthcare Commercial and Medicare Advantage members' professional claims submitted for reimbursement for drug-related codes to include the NDC number, quantity and the unit of measure.
This requirement applies to paper claim form CMS-1500 and Electronic Data Interface (EDI) transaction 837P when billed for drug-related healthcare common procedure coding system (HCPCS) codes and drug-related current procedure terminology (CPT) codes. The NDC, quantity and the unit of measure will be enforced in addition to the corresponding HCPCS and CPT codes and the units administered for each code.
Please note: Hospital facility outpatient claims will not be subject to enforcement at this time.
Please refer to the National Drug Code Requirement Frequently Asked Questions for detailed information on submitting standard claims with NDC information.
Specific UnitedHealthcare Claims Submission Process for NDC-Contracted Care Providers
What is an NDC-Contracted Care Provider?
An NDC-contracted care provider, typically home infusion and/or a specialty pharmacy provider, is a care provider contracted to be reimbursed by NDC methodology for professional claims submitted to UnitedHealthcare's NDC drug pricer.
NDC-Contracted Provider Claim Submission
NDC-contracted care providers must follow specific claims submission instructions and inquiry procedures when billing drugs/NDC. Claims can be submitted utilizing the Claim Submission feature on this website and/or via EDI claims submission using the unique payer ID of "UHNDC". New submitters must complete end-to-end testing before submitting claims electronically to this payer ID. Contact your clearinghouse to begin the testing process and/or UnitedHealthcare EDI Support (800-842-1109) for more information.
Refer to the NDC Claim Submission and Inquiry Guide for detailed information on submitting NDC claims.