Wednesday, June 18, 2008

PHP TennCare has special requirements for reporting NDC info

RelayHealth has been informed that CPIDs 1893 and 8585 PHP TennCare has special requirements for reporting NDC information. The payor is requiring all providers to comply with the TennCare NDC/J-code regulations. In order to accomplish this, providers must send the following information when a J-code is present on a claim:
If Loop 2400 SV1 contains a J-code, then Loop 2410 must contain an LIN segment with the LIN02 and LIN03 elements populated.
LIN02 = N4 qualifier
LIN03 = NDC Code

If Loop 2400 SV1 contains a J-code, then Loop 2410 must contain a CTP segment with the CTP03, CTP04, and CTP05 elements populated.

CTP03 = Unit Price
CTP04 = Quantity
CTP05 = Composite Unit of Measure

Note: If the CTP segment would contain the same exact information that is sent in the SV1 segment, then the CTP segment is not necessary, otherwise it is required.
Action Required: Please make the necessary changes to your system to comply with this payor requirement and to prevent claim rejections.

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