NDC mandates have been in place for Medicaid covered lives for over a decade. In recent years, this requirement has been expanded to account for additional lines of business. This shift creates a larger member population which in turn creates new claim volume. The addition of the volume mixed with the requirement for electronic claim submissions puts pressure on both payors and providers if the people, processes and system infrastructure aren’t in place. The challenge is even more complex for providers who have multiple systems for managing patients, billing, and collections. Any inconsistency in data brings exposure and can result in improperly coded claims and lack of policy adherence.
The above excerpt is from “Automated Controls for Medical Drug Spend” by RJ Health’s Chief Innovation Officer, George Herchenroether.
Appropriate reimbursement for drugs covered by the medical benefit requires more data and structure than most medical claims or billing systems were originally intended to process:
If you found this information about medically covered drugs helpful, you may also like to register for our upcoming webinar, Creating Pre-Payment Controls for Medically Covered Drug Costs through Automation.