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September 2017
RC Claim Assist tool ensures correct billing units on medical drug codes
To help you bill claim units more easily, use the RC Claim Assist tool. It’s available to all Blue Cross Blue Shield of Michigan and Blue Care Network contracted providers at no cost.
RC Claim Assist can help you make quick and easy conversions from HCPCS/CPT units to NDC units. As electronic billing at the NDC unit level becomes more of an industry standard, this tool helps you to correctly submit medical pharmacy claims.
To complete a units conversion, include the:
- HCPCS or CPT code
- NDC code
- HCPCS or CPT units administered
Steps to follow
- Select the drug reimbursement code.
- Enter the number of HCPCS or CPT units administered.
- Scroll down to see the correct NDC billable units that appear in the dark blue box on the right side of your screen (see screen shot below).
- View the average wholesale price, or AWP, displayed below the NDC billable units.
Tips to help you use the RC Claim Assist tool
- You can use any of these starting points to retrieve the NDC billable unit:
- HCPCS or CPT code
- NDC code
- Drug name
- Refer to the tool only as a general reference and in conjunction with other resources, such as applicable fee schedules.
- Check for information at the exact time of day you need it to ensure it’s valid.
Tips for submitting NDC codes on medical pharmacy claims
To correctly submit claims electronically, using the ANSI 837P format, include:
- The 11-digit NDC code along with the applicable HCPCS or CPT code.
- All the information shown in the chart below, along with the correct NDC billable units found using the RC Claim Assist tool.
Electronic billing example:
SV1˜HC*90647˜66˜UN˜1˜˜˜2:
DTP˜472˜D8˜20160115:
REF˜6R˜266403606:
LIN˜˜N4˜00006489700:
CTP˜˜˜˜.5˜ML:
How to access RC Claim Assist instructions
For RC Claim Assist access instructions, please refer to the April 2017 Record article. It will help you through the tool’s registration process and direct you to the login page.
Questions about the RC Claim Assist tool?
Email RJ Health Systems at info@rjhealthsystems.com if you have questions about RC Claim Assist. You may also review the About and FAQ sections at the top of the RC Claim Assist home page** for more information on how to use the tool.
Questions about NDC billing?
If you have any questions about finding the NDC code and unit of measure or submitting the NDC on paper claims, refer to the February 2015 Record article.
**Blue Cross Blue Shield of Michigan doesn’t own or control this webs
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