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
Anthem Blue Cross and Blue Shield is implementing National Drug Code (NDC) validation edits for Medicare Advantage claims 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 not greater than 0 or exceed 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 audit all current NDC submission practices and implement system edits to enforce validation rules. Specific actions: (1) Verify all NDCs submitted are exactly 11 numeric digits with no spaces, special characters, or alphabetic characters; (2) Configure billing system to reject or flag NDCs containing disallowed values (99999999999, 99999999992, 99999999993, 99999999994, 99999999995, 99999999996); (3) Set system validation to ensure NDC unit counts are greater than 0 and do not exceed 9,999,999.999; (4) Update provider documentation and billing guidelines to reflect NDC formatting requirements; (5) Test billing system edits with sample claims before August 1 effective date. Consequence of inaction: Medicare Advantage claims with invalid NDCs will be rejected by Anthem, resulting in claim denials and delayed reimbursement. Providers should review billing practices immediately.