Medicare AdvantageAdministrativeHigh impact
[Georgia] NDC edits for Medicare Advantage claims
Anthem BCBS·GA · Pharmacy·Medicare
Effective date
Aug 1, 2026
We identified it
Aug 3, 2026
Summary
Anthem Blue Cross and Blue Shield (Georgia) is implementing NDC 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 in all pharmacy claims submitted to this plan.
Action Required
By August 1, 2026: Billing team must audit and validate all NDC formatting in pharmacy claims submitted to Anthem Georgia Medicare Advantage plans. REQUIREMENTS: (1) Verify all NDCs are exactly 11 numeric digits with no spaces, special characters, or alphabetic characters in billing system; (2) Remove or correct any NDCs containing disallowed values (99999999999, 99999999992, 99999999993, 99999999994, 99999999995, 99999999996); (3) Ensure NDC unit counts are greater than 0 and do not exceed 9,999,999.999 on all pharmacy claims; (4) Update pharmacy billing software validation rules to enforce these requirements; (5) Train billing and pharmacy staff on correct NDC entry procedures. CONSEQUENCE: Claims not meeting these requirements will be rejected by Anthem and CMS will not accept encounter submissions, resulting in claim denials and revenue loss.