CommercialBilling CodesHigh impact
24-432m Submit Claims With Valid National Drug Codes to Ensure Payment
Health Net·CA·Pharmacy
We identified it
Jun 20, 2026
Summary
Health Net now requires valid National Drug Codes (NDC) along with HCPCS/CPT codes on all drug claims for reimbursement. Claims missing NDC information, unit of measure, or units dispensed will be denied and must be resubmitted with complete NDC details.
Action Required
Immediately: Billing team must update all drug claim submissions to include valid 11-digit NDC numbers in 5-4-2 format (no spaces/hyphens), unit of measure, and units dispensed. Update billing software to require NDC qualifier, number, quantity and unit of measure for all drug claims on CMS-1500 (box 24D) and UB-04 (box 43) forms. Verify NDC is active for date of service. Claims without complete NDC information will be denied.