National Drug Codes (NDC) on Medicare Crossover Claims

March 21, 2012

Effective immediately, only Medicare Crossovers claims submitted to Medicare on a 5010 claim will show the NDC data in the 2410 LIN segment when the claim is forwarded to MaineCare through the COBA file.

If a provider submits a 4010 claim to Medicare, the NDC data will not cross over when it is moved into 5010 production. Although the file will be “stepped up” to a 5010 claim, it will not contain the NDC information. Claims that do not have NDC information will deny. Therefore, when submitting a 4010 claim, providers can either edit their claim to include the NDC information using Direct Data Entry or send in a paper claim with the Medicare Explanation of Benefits (EOB) attached to the claim.