Independence has adopted new claims reporting requirements for drugs obtained from in-network home infusion vendors. The following information is required when submitting drug claims for home infusion vendors that are not owned by a hospital or health system in the Independence provider network:

• NDC. Report the specific National Drug Code (NDC) that corresponds to the drug formulation administered to the member.
• HCPCS or CPT^® codes. Report the specific Healthcare Common Procedure Coding System (HCPCS) or Current Procedural Terminology (CPT) code for the drug. Exception: For drugs without a specific HCPCS/CPT code, report the J3490 or J3590 not otherwise classified (NOC) code, as appropriate.
• Units of drug administered. Report drug units in multiples of the dosage unit specified in the HCPCS/CPT code narrative. Exception: For drugs without a specific HCPCS/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: The submission process for precertification requests through the NaviNet^® web portal has not changed.

For more information

Effective March 1, 2016, the following claim payment policies have been 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 these policies by visiting our Medical Policy Portal. Select Accept and Go to Medical Policy Online, and then select the Commercial or Medicare Advantage tab from the top of the page, depending on the version of the policy you?d like to view. Then type the policy name or number in the Search field.

Please note that this change only applies to home infusion vendors that are not owned by hospitals or health systems in the Independence provider network. Home infusion vendors owned by hospitals or health systems in the Independence provider network should continue to bill according to the terms of their Provider Agreement.

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