M119 denial code description and corrective action

• NDC is required for drug procedure codes that start with alphabets, such as J7649.

• This denial occurs when NDC is required but missing in the claim.

• It may also occur when we use an outdated or wrong NDC.

Actions

• First, we need to verify the status of the claim. This can be done by checking the status through the insurance web portal or by calling the payer.

• The most important step is to determine whether the claim denial is valid or if the insurance has denied the claim by mistake.

• Call the insurance company and ask the representative to provide the correct NDC. If the rep provides the correct NDC and we also billed the claim with the same NDC, then ask the rep to verify the NDC present on the claim. If it is found that the claim is billed with the correct NDC, then ask the representative to reprocess the claim. Be sure to note the claim number, rep name, and call reference number, and then follow up on the claim after the provided TAT.

• If the rep provides the correct NDC but we billed either the wrong NDC or missed the NDC, then we submit a corrected claim with the updated NDC.

• Medicare does not accept corrected claims, so in the case of any denial, a new claim must always be submitted.

• If the rep does not provide the NDC, then we can also use Google to find the updated NDC.

• If we are not able to find the correct NDC from any resource, then we contact the client for suggestions.

• For submitting an corrected claim, must calculate the timely filing limit starting from the processed date. If the limit has been exceeded, the claim will be denied again for exceeding the filing deadline. In such cases, we should consult with the provider. Some clients may still want us to submit the corrected claim even after the timely filing limit has passed, so we should proceed according to their instructions.

Description