Rj health s saas provides data regarding the number of billable hcpcs code units that are associated with each ndc. Bcbsil contracted providers may access the ndc units calculator tool at no cost through our secure provider portal, blue access for providerssm, or via the availity web portal. Thank you for visiting specialty drug managements ndc units calculator tool. Today we would like to help you by answering the most frequently asked question about rj health data. A free inside look at rj health systems salary trends based on 3 salaries wages for 3 jobs at rj health systems. Vaccine national drug code ndc the goal of these pages is to facilitate the use of ndc to identify vaccines.
How often does rj health systems update the ndc information in rc claim assist. This page provides information about hcpcs j76 to ndc mapping. Rj health, an independent thirdparty specialty drug data company, has provided a newly. Rj health is an independent third party pharmaceutical. Frequently asked questions for blue cross and bcn providers march 2017 n. I need to know if there is a formula for calculating mg to ml and if so, where i might find it. Drug database medical device database fdb first databank. Rj health, an independent thirdparty specialty drug data company, has. Providers may search for billable ndc units by hcpcscpt code. All content is posted anonymously by employees working at rj health systems. When youre submitting a claim with ndc information, you must include. We also have a unit conversion calculator which can apply a single code unit dose and then apply it to an ndc and convert to those ndc units.
Rj health, an independent thirdparty specialty drug data company, has provided a newly updated units. Billing with national drug codes blue cross and blue shield of texas bcbstx reimburses claims submitted with national. Explained webinar segment this segment is from rj health s on. How to report ndc code on cms 1500 medical billing and. Texas medicaid and children with special health care needs cshcn services program providers must submit both healthcare common procedure coding system hcpcs units and national drug code ndc units on any drug claims. Rj health, an independent thirdparty specialty drug data company, has provided a newly updated units calculator tool, which is now known as rc claim assist. Hcpcscpt to ndc crosswalk manufacturer for drug inquiry, with ndc level rebate flag hcpcs to ndc unit of measure conversion factors. Availity provider portal to access the rj health ndc units calculator. The ndc number consists of 11 digits in a 542 format, and all digits must be present and in the prescribed format for the number to be considered complete.
First, wed like to do a quick orientation to some of the applicable data. Billing with national drug codes health insurance texas. Diving program office of marine and aviation operations. View and compare coding and reimbursement rates, including awp, wac, asp and apc rates which have proprietary code level price. How can i reduce the amount of misaligned hcpcscpt and ndc codes my team deals with. The ndc units calculator tool that you know has been updated to a new tool rebranded by reimbursement codes rc claim assist. Influenza vaccine products for the 20152016 influenza season.
Reminder for calculating hcpcs and ndc units information posted january 29, 2016 reminder. Rj health systems, an independent thirdparty specialty drug data company, has provided a. The ndc units calculator tool is hosted by rj health, an independent third party pharmaceutical specialty company. Billing with national drug codes ndcs frequently asked. Advancing medication decision support with smarter drug databases and software solutions. Advance beneficiary notice of noncoverage abn tutorial hover over form fields to identify details required for each.
Of the new data available to everyone in the essential license, weve noticed more people using our ndc conversion calculator tool. We partner with multiple service organizations to provide solutions to manage medical drug spend in many different ways. Ndc units calculator tool available on the availity provider portal at. Effectively identify drugs that are eligible for medicaid rebates. Ndc dosage calculations medical billing and coding forum. Billing with national drug codes ndcs frequently asked questions. Rj health provides guidance to pharmaceutical companies to ensure that drugs are billed and coded accurately. Administrative law judge alj calculator calculate alj request submission deadline. The ndc units calculator tool is hosted by rj health, an. Improving claim submission accuracy starts with provider engagement through greater transparency by. Simply enter in the date of service and number of units of the code and our new ndc calculator will apply that datato show the final calculated price for the code. The asp crosswalks support aspbased medicare part b payments only. The crosswalks are not intended to be a comprehensive list of all drugsndcs available in the united states. Product classification food and drug administration.
Rj health systems has the data to solve for issues related to obtaining medicaid rebates for physician administered drugs. Yes we gave 2 vials of the 100mg10ml and 1 vial of the 40mg4ml, but i dont think billing 2 and 1 for the dosage would be correct. Ptcb national drug code national drug code ndc 1st section. How can i enable my providers to submit claims correctly using ndc codes. Optimization of specialty drug cost under the medical benefit part 01. How to report ndc code on cms 1500 guidance regarding ndcs on the cms1500 form effective august 2008, alabama medicaid mandated that the national drug code ndc number be included on the cms1500 claim form for the top 20 physician administered drugs as defined by cms. Updated resources online ndc units calculator tool now.
The purpose of the ndc crosswalk tables is to show the relationships of vaccine primary and secondary packaging ndcs and provide related information for use as reference data for solutions that leverage ndcs. We will assume that you have some basic knowledge about medical claims, and well. Medicare claims processing manual chapter 17 drugs and. Ndc dosage yes i know that we would bill 240 mg of j9299 but i need to know how many ml to bill for the ndc dosage. Rj health systems has established and continuously maintains a library of drug intelligence that provides the most comprehensive, trusted, and up.
Office of in vitro diagnostics and radiological health oir submission type. Get unit based pricing on every code and ndc where applicable. Rc claim assist from rj health gives providers the actionable coding and units needed to accurately bill for drugs administered against the medical benefit as a provider, once registered with this site, you will be able to convert hcpcpscpt units to ndc units. Hcpcs or current procedural terminology cpt units to ndc units. Please note, this does not take into account any level of fee schedule. Vaccine product billing code2 nvs influenza vaccines longer payable for. A recent rj health claims analysis revealed confusion from providers on what is needed to meet ndc unit mandates. This cr provides direction in using the lin segment to identify a drug or biological using the ndc code and the ctp segment to specify the unit of measurement and the metric decimal quantity of the drug or biological. Rj health systems calculator will be enhanced to include noc codes, allowing the ability to select the various units of measure. A division of health care service corporation, a mutual legal reserve company, an independent licensee of the blue cross and blue. Avoid human calculation errors with the calculator.
Below is the transcript from our ondemand microwebinar. Provide your provider network with a direct portal to your reimbursement policies and how to submit claims using correct hcpcscpt and ndc crosswalks. Introducing the new reimbursement codes reimbursementcodes. The crosswalks are intended to help understand which drug products identified by ndcs are assigned to which hcpcs billing codes. To access the tool, please find links available on the. Our solutions can guide you in establishing pricing and reimbursement policy, analyze. When a code in rc claim assist has a strikethrough in it, what does it mean.
Units need to be billed at the appropriate metricunit of measure that is standard for the ndc code. Updated online ndc units calculator tool available. Gems are like guides that list a code from one set and its. Weve flipped the script on the current state of medication decision support. Bcbsok approves coverage of new shingles vaccine shingrix. Salaries posted anonymously by rj health systems employees. National drug code description the ndc, a number that identifies a specific drug, is found on the drug container vial, box, bottle or tube.
In order to help coders, the national center for health statistics created a set of tools, called general equivalency mappings, or gems. Code to ndc conversion calculator for ndc unit billing. The new reimbursement codes created for you rj health. The data are updated on the first business day of each month. Students perform a giant stride from the noaa diving center ndc pier as ndc instructor katie mahaffey watches. The ndc units calculator tool is hosted by rj health, an independent third. Improving claim submission accuracy starts with provider engagement through greater transparency. I consider team feedback both good and bad as key to rj health s continued success. Reimbursementcodes offers pharmaceutical companies comparable intelligence on medically covered drugs in the health care system. Streamlined workflow comprehensive display of the drug card includes code level pricing and the ndc crosswalk for each. Each ndc includes ndc level pricing, billable units, status indicators for brandgeneric, single dosemulti dose vial, activeinactive ndc status with corresponding effective dates, and cms rebatable indication. Using ndcs on medical claims facilitates more accurate payment and. Crosswalking between icd10cm and icd9cm became an extremely important skill for coders to learn during the transition period from icd9 to icd10. Rj health systems reimbur, an ndc coding product optum360s, which includes ndc coding.
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