Medicare AdvantageAdministrativeHigh impact
[Virginia] NDC edits for Medicare Advantage claims
Anthem BCBS·VA·Medicare
Effective date
Aug 1, 2026
We identified it
Aug 2, 2026
Summary
Anthem Blue Cross and Blue Shield is implementing NDC (National Drug Code) validation edits for Medicare Advantage claims effective August 1, 2026, to align with CMS encounter requirements. Claims will be rejected if the NDC is not exactly 11 numeric digits, contains disallowed values (99999999999, 99999999992-99999999996), or if the NDC unit count is not greater than 0 or exceeds 9,999,999.999. Billing teams must audit and correct NDC formatting on all drug claims to prevent denials.
Action Required
By August 1, 2026: Billing team must implement validation rules in billing software to ensure all NDC fields on Medicare Advantage claims meet CMS requirements. SPECIFIC ACTIONS: (1) Audit current billing procedures to identify claims with NDC formatting errors, spaces, special characters, or alphabetic characters; (2) Update billing system edits to reject NDCs that are not exactly 11 numeric digits before submission; (3) Configure system to block submission of disallowed NDC values (99999999999, 99999999992, 99999999993, 99999999994, 99999999995, 99999999996); (4) Validate that all NDC unit counts are greater than 0 and do not exceed 9,999,999.999; (5) Train billing staff and providers on correct NDC formatting requirements. Notify providers to review their documentation and billing practices. CONSEQUENCE: Claims submitted with invalid NDC formatting will be denied by Anthem and will not be accepted for CMS encounter submission.