Medicare AdvantageAdministrativeHigh impact
[Ohio] NDC edits for Medicare Advantage claims
Anthem BCBS·OH·Medicare
Effective date
Aug 1, 2026
We identified it
Aug 3, 2026
Summary
Effective August 1, 2026, Anthem Blue Cross and Blue Shield (MyCare Ohio) is implementing NDC validation edits for Medicare Advantage claims to align with CMS encounter requirements. Claims will be rejected if the NDC is not exactly 11 numeric digits, contains disallowed values (99999999999, 99999999992-996), or if the NDC unit count is ≤0 or exceeds 9,999,999.999. Billing teams must audit and correct NDC formatting in their systems immediately to prevent claim denials.
Action Required
By August 1, 2026: Billing team must implement the following: (1) Audit all current NDC submissions to ensure they are exactly 11 numeric digits with no spaces, special characters, or alphabetic characters; (2) Update billing software validation rules to reject NDCs that are not 11 digits or contain disallowed values (99999999999, 99999999992, 99999999993, 99999999994, 99999999995, 99999999996); (3) Verify NDC unit counts are greater than 0 and do not exceed 9,999,999.999 before claim submission; (4) Train providers and billing staff on correct NDC formatting requirements; (5) Establish pre-claim edit checks in the billing system to catch NDC validation errors before submission. Failure to comply will result in claim denials from Anthem Medicare Advantage plans and rejection of encounter data by CMS.