MedicaidBilling CodesHigh impact
REVISED: New Edit for 340B Medical Billing
Arkansas Medicaid·AR · General Practice, Family Medicine, Internal Medicine +9 more·Claims & Billing
Effective date
Aug 1, 2025
We identified it
Jul 28, 2025
Summary
Arkansas Medicaid ended the 90-day grace period for NDC (National Drug Code) billing errors. Effective August 1, 2025, all claim lines not billed in accordance with Arkansas Drug Procedure (HCPCS/CPT) to NDC relationship requirements will be denied instead of paid. Providers must ensure claims comply with NDC billing instructions in their provider manual section II or face claim denials.
Action Required
By July 31, 2025: Billing team must audit and update all billing processes to ensure NDC-to-HCPCS/CPT coding compliance. Providers must review Section II of their applicable Arkansas provider manual (references include Ambulatory Surgical Center §242.400, Hospital §272.102, Physician §292.910, and others as listed). Implement NDC Units Calculator tools from approved vendors to validate units on all drug claims before submission. Billing staff must verify all drug procedure codes map correctly to NDC codes and that submitted units match covered HCPCS units. After August 1, 2025, any claims with incorrect NDC-to-code relationships will be denied; there will be no grace period. Update claim submission workflows to flag NDC discrepancies for review before billing. EOB code 1257 (Submitted NDC Units Greater than Covered HCPCS Units) will appear on remittance advice for informational purposes only and will not result in payment.