Medicare AdvantageAdministrativeHigh impact
[California] NDC edits for Medicare Advantage claims
Anthem BCBS·CA · Pharmacy·Medicare
Effective date
Aug 1, 2026
We identified it
Aug 2, 2026
Summary
Anthem Blue Cross Medicare Advantage is implementing new NDC (National Drug Code) validation edits effective August 1, 2026, to align with CMS encounter requirements. Claims will be rejected if NDCs are not exactly 11 numeric digits, contain disallowed values (99999999999, 99999999992-99999999996), or if NDC unit counts are ≤0 or exceed 9,999,999.999. Billing teams must audit and correct NDC formatting in all Medicare Advantage pharmacy claims.
Action Required
By July 31, 2026: Billing team must audit all Medicare Advantage claim submission processes to ensure NDC formatting compliance. REQUIREMENTS: (1) Verify all NDCs in billing system are exactly 11 numeric digits with no spaces, special characters, or alphabetic characters; (2) Remove or exclude the six disallowed NDC values (99999999999, 99999999992, 99999999993, 99999999994, 99999999995, 99999999996) from system lookup tables; (3) Validate that NDC unit counts submitted are >0 and do not exceed 9,999,999.999; (4) Update billing software validation rules to enforce these three requirements; (5) Train all staff submitting pharmacy claims on proper NDC formatting. CONSEQUENCE: Claims failing NDC validation will be rejected by Anthem and CMS, resulting in payment denial and rework.