Medicaid outpatient medication claims NDC requirement
Requires that professional and institutional outpatient medical benefit claims for medication-related HCPCS codes for Neighborhood Health Plan of Rhode Island Medicaid members include the administered drug's NDC; claims with NDCs not enrolled in the Medicaid Drug Rebate Program (MDRP) will be denied.
Effective April 1, 2023, Neighborhood requires all professional and institutional outpatient medical benefit claims for medication-related HCPCS codes for Neighborhood Medicaid members to include the corresponding NDC administered to the member.
If the NDC of the administered medication is not enrolled in the MDRP, the claim will deny.
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