Thursday, January 21, 2016

Hospital billing rejection on Maternity room and NDC number

Maternity Room and Board Revenue Codes;

Molina is finding that some maternity claims have either denied or paid zero. Upon researching the claims, Molina discovered that the claims in question were billed without maternity room and board revenue codes. Please keep in mind that although there may be some circumstances when you do not need a maternity revenue code, the claims will process more efficiently if you are billing the appropriate maternity room and board revenue code when applicable.

 NDC Billing Instructions

Molina EDI Help Desk is reporting claims are being rejected because more than one NDC code is being billed on one service line. Below you will find instructions on billing multiple NDC codes for the same drug on a claim. For more detailed information on billing NDC codes, please see the
BMS website at On this site, you will find a listing of drug codes and whether or not they require a NDC, Frequently Asked Questions, a provider notice and a list of manufacturers that participate in the rebate program.

Multiple NDCs

At times, it may be necessary for providers to report multiple NDCs for a single procedure code. For codes that involve multiple NDCs (other than compounds, see BMS website), providers must bill the procedure code with KP modifier and the corresponding procedure code, NDC qualifier, NDC, NDC unit qualifier and NDC units. The claim line must be billed with the charge for the amount of the drug dispensed for the NDC identified on the line. The second line item with the same procedure
code must be billed utilizing KQ modifier, the procedure code units, charge and NDC information for this portion of the drug.

Split Billing

Reminder: Molina updates the hospital contracts every July 1st and October 1st. If you are billing an outpatient claim that extends from June to July or September to October, it is important for you to split the claim into two claims, one date ending on June 30th or September 30th, and the next claim beginning on July 1st or October 1st.

Please Note: Inpatient acute care claims cannot be split billed; must be billed upon discharge only.

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