Reimbursement Policies Updated in June 2026

By 06/15/2026 (policy approval date - immediate compliance required): 1) Billing team must update all billing system software to mandate NDC submission in 5-4-2 format (11 digits, no spaces/hyphens) with leading zeros if needed for ALL outpatient drug claims billed to Healthfirst plans. 2) Implement system validation rules requiring UOM qualifier (UN, ML, ME, GR, F2, or IU) for every NDC submission. 3) Modify claim submission templates to capture actual administered drug quantity in decimal format (e.g., 0.5, 1, 2), not vial size, with mandatory alignment to HCPCS/CPT units. 4) For 340B-qualified providers: Configure billing system to automatically append UD modifier to all 340B outpatient drug claims. 5) Providers and coders must verify NDC is active on date of service and accurately matches the drug administered. 6) Update internal billing procedures and staff training on UOM guidelines (e.g., UN=tablets/vials, ML=liquids, ME=milligrams, GR=grams/creams, F2=IU products). 7) For paper claims (CMS-1500): Ensure Line 24A contains NDC data in format 'N412345678901UN1' with no spaces. For institutional claims (UB-04): Use Form Locator 43 with same format. For electronic claims (837P/837I): Map NDC to Loop 2410 LIN segment and quantity/UOM to CTP segment per ANSI X12 5010 standards. Failure to comply will result in claim denials, reprocessing delays, and potential recoupment of incorrectly paid claims.