21-517m Reminder: Submit Claims with Correct Coding to Avoid Rejections
Date: 07/16/21
This information applies to Physicians, Participating Physician Groups (PPGs), Hospitals, and Ancillary providers.
For Medi-Cal, this information applies to Kern, Los Angeles, Riverside, Sacramento, San Bernardino, San Diego, San Joaquin, Stanislaus, and Tulare counties.
How Health Net processes Medi-Cal claims with an NDC and HCPCS code
When Health Net receives a Medi-Cal claim with both a National Drug Code (NDC) and a HCPCS code, Health Net applies line-level claim edits to determine:
- Is the NDC valid?
- Is the HCPCS code valid?
- Is the NDC/HCPCS code combination valid?
If the response to any of the above questions indicates an invalid code or invalid code combination, Health Net will contest the claim to ask for corrected billing.
Additional information
To better reflect current processes, relevant sections of Health Net’s provider operations manuals have been revised to reflect the information contained in this update as applicable. Provider operations manuals are available electronically in the Provider Library, located on Health Net’s provider website.
Access information about billing NDCs in the Provider Library. Select Medi-Cal > Provider Manual > Claims and Provider Reimbursement > Billing and Submission > National Drug Codes for Medi-Cal Claims.
Providers are encouraged to access Health Net’s provider portal online for real-time information, including eligibility verification, claims status, prior authorization status, plan summaries, and more.
If you have questions regarding the information contained in this update, contact the Health Net Provider Services Center by email within 60 days, by telephone or through the Health Net provider website as listed below.
Line of Business | Telephone Number | Provider Portal | Email Address |
|---|---|---|---|
Medi-Cal | 1-800-675-6110 |
| N/A |