GHP Family high-cost drug billing policy

IMMEDIATE: Billing team must implement the following changes to comply with GHP Family high-cost drug billing policy: (1) Update billing system to require Revenue Code 636 for all high-cost drug claims; (2) Ensure all high-cost drug claims include 11-digit NDC (no hyphens) in the appropriate form fields—CMS-1500 Item 24A-24G shaded sections, UB-04 Form Locator 43 Revenue Description Field, or EDI Loop 2410 LIN3; (3) Configure system to submit all high-cost drug claims as 837 Institutional type only; (4) Verify each high-cost drug is billed as a single separate line item, never bundled with other services; (5) For inpatient high-cost drugs: bill on separate service line with NDC and units; do NOT include administration services on same claim—submit administration separately; (6) Establish verification process to confirm all drug products are marketed by Federal Medicaid Drug Rebate Program participants; (7) For Lyfgenia and Casgevy (sickle cell): verify inpatient administration setting and CIBMTR registry enrollment before processing claims. Update encounter forms and provider documentation templates to capture required NDC and eligibility information. Train all billing staff on new Revenue Code 636 and NDC reporting requirements. Non-compliance will result in claim denials and potential audit findings.