Medicare AdvantageAdministrativeHigh impact
[New York] NDC edits for Medicare Advantage claims
Anthem BCBS·NY·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 between 0 (exclusive) and 9,999,999.999. Billing teams must audit and correct NDC formatting in their systems to prevent claim denials.
Action Required
By August 1, 2026: Billing team must implement validation controls in billing software to enforce NDC formatting rules: (1) NDC must be exactly 11 numeric digits with no spaces, special characters, or alphabetic characters; (2) NDC must not contain the disallowed values (99999999999, 99999999992, 99999999993, 99999999994, 99999999995, 99999999996); (3) NDC unit count must be greater than 0 and not exceed 9,999,999.999. Audit all active drug claims in the system for compliance and correct any non-compliant NDC entries. Train billing staff on validation requirements. Configure system edits to reject claims with invalid NDCs before submission to Anthem Medicare Advantage plans. Failure to comply will result in claim denials and encounter submission failures.