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[California] Pharmacy NDC Validation
Act
by Apr 1, 2026
Effective date
Apr 1, 2026
Identified
May 3, 2026
Summary
Anthem Blue Cross (California) is enforcing stricter National Drug Code (NDC) validation requirements for all pharmacy claims submitted to them, effective April 1, 2026. Providers must submit 11-digit NDCs in proper format with correct units of measure (UOM) and quantities on all drug-related professional and outpatient claims. Missing, incorrectly formatted, or mismatched NDCs will delay reimbursement.
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What to do
by Apr 1, 2026 · 11 steps
01Billing team must implement the following changes.
02Update billing software to require 11-digit NDCs with no hyphens or spaces in the format N4 + 11 digits + UOM + quantity for all drug-related claims.
03Configure system to validate NDCs match the administered unit container (not box/bulk packaging).
04Establish validation rules to prevent submission of 10-digit NDCs or leading zeroes omission.
05Configure UOM validation to accept only F2, GR, ME, ML, or UN codes with appropriate decimal formatting (maximum 8 digits before decimal, 3 after).
06Train all billing staff and providers on correct NDC submission format using provided examples and Availity Essentials NDC/UOM crosswalk.
07Update encounter forms and claim templates to include NDC, UOM, and quantity fields.
08Implement edits to flag mismatches between NDC units and HCPCS code units.
09For compound drugs, configure system to report each NDC on separate line with modifiers KP (first) and KQ (subsequent).
10Program system to exempt radiopharmaceuticals, hemophilia drugs, gene therapy drugs, G codes, and P codes from NDC requirements.
11Consequences: Claims with missing, incorrectly formatted, or invalid NDCs will be delayed or denied, impacting reimbursement timelines and member experience.
Codes mentioned
J0177J0858J2405J9271J0696
Original notice
[California] Pharmacy NDC Validation
providernews.anthem.com · Always check the source before changing claims.
Related changes
See all Anthem BCBS changes →[California] National Drug Codes (NDCs) are required for outpatient claimsHighEffective Apr 20, 2026 · Pharmacy[New York] National Drug Codes (NDCs) are required for outpatient claimsHighEffective Apr 17, 2026 · Pharmacy[Virginia] National Drug Codes (NDCs) are required for outpatient claimsHighEffective Apr 17, 2026 · Pharmacy[New York] Specialty pharmacy updates, March 2026HighEffective Jun 1, 2026 · PharmacyBrowse every Anthem BCBS change in the policy list