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Claims Reminder

When submitting a claim, it’s important to provide taxonomy information for the claim. Not only is this information used when reviewing and processing a claim, but it is also used within various file feeds we are required to submit to third-party vendors for specific lines of business.

In addition to the taxonomy details, you must also include the following related information for your claim to be accepted and reviewed for possible benefits at the NDC level. Please include:

  • The applicable HCPCS or CPT code
  • Number of HCPCS/CPT units
  • NDC qualifier (N40)
  • NDC unit of measure (UN, ML, GR, F2)
  • Number of NDC units (up to three decimal places)
  • You must also include your billable charge.

Here is a sample of how the NCD information is populated on claims:

SV1*HC:99211:25*12.25**UN*1*11**1:2:3**Y~

We encourage providers to refer to ANSI guides, internal resources, and the system they use for specifics around this field.

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