Home Administrative Billing & Reimbursement BlueCard® Health and Wellness Medical PEAR portal Pharmacy Products Quality Management

Upcoming changes to claims reporting requirements for home infusion providers

December 30, 2015

Effective March 1, 2016, Independence will adopt new claims reporting requirements for drugs obtained from in-network home infusion providers. The following information will be required when submitting all home infusion drug claims:

  • NDC. The specific National Drug Code (NDC) that corresponds to the drug formulation administered to the member must be reported.
  • HCPCS or CPT® codes. The specific Healthcare Common Procedure Coding System (HCPCS) or Current Procedural Terminology (CPT) code for the drug must be reported. Exception: For drugs without a specific HCPCS or CPT code, report the J3490 or J3590 not otherwise classified (NOC) code, as appropriate.
  • Units of drug administered. Drug units must be reported in multiples of the dosage unit specified in the HCPCS/CPT code narrative. Exception: For drugs without a specific HCPCS or CPT code, report the units in multiples of the drug units specified in the NDC.

Failure to include these components in a claim may result in delayed processing and reimbursement.

Note: Precertification requests submitted through the NaviNet® web portal will continue to follow the same submission process that is in effect today.

For more information

The following claim payment policies are being updated to address these new billing requirements and provide specific claims examples:

  • Commercial: #00.01.49b: Reporting Requirements for Drugs and Biologics
  • Medicare Advantage: #MA00.024a: Reporting Requirements for Drugs and Biologics

View the Notifications for these policies by visiting our Medical Policy Portal. Select Accept and Go to Medical Policy Online, and then select Commercial or Medicare Advantage under Active Notifications.

We ask that you review these policies in their entirety and share them with your staff so they can become familiar with the new requirements prior to March 1, 2016.

NaviNet is a registered trademark of NaviNet, Inc., an independent company.

CPT copyright 2014 American Medical Association. All rights reserved. CPT is a registered trademark of the American Medical Association.


This content was prepared for the Provider News Center and may not be reproduced in any way without the express written permission of Independence Blue Cross. Independence Blue Cross is an independent licensee of the Blue Cross and Blue Shield Association.
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