New Physician Drug Program Edits on October 1

Two new Physician Drug Program edits are being implemented in NCTracks on October 1. Edit 02672 will compare the J code billed with the Generic Code Number (GCN) to ensure it is a valid combination. If the claim fails the edit, it will deny and post Explanation of Benefits (EOB) 02672 - SERVICE DENIED. J CODE + NDC/GCN COMBINATION IS NOT VALID. Edit 02673 will compare the NDC/GCN code with the diagnosis code (ICD 9/10) billed to ensure it is a valid combination. If the claim fails this edit, it will deny and post EOB 02673 - SERVICE DENIED. NDC/GCN + ICD DIAGNOSIS COMBINATION IS NOT VALID.

Providers will continue to bill with the NDC. These edits are taking the place of a manual review process, so claims will process more efficiently. The edits apply to Medicaid and Health Choice benefit plans. Both edits have an effective date of January 1, 2015, but will be applied based on date of processing of the claim, not date of service.