The 11-digit format is 5-4-2 and is found on most drug packaging. This format serves a functional purpose: The first segment of the NDC identifies the labeler/manufacturer; the second segment identifies the product, strength, dosage form, and formulation; and the third segment identifies the package size of the drug.
If the NDC on the drug packaging is in any format other than 5-4-2, it is essential that you update the numbers accordingly, using zeros as placeholders. Always use placeholders (zeros) in front of the number that is missing digits. Please do not include spaces, decimals, or other characters in the 11-digit string. See the March edition of Partners in Health Update for examples.
Certain claims for unlisted and nonspecific drug codes that are not accompanied by an NDC in the correct format and location will not be processed and will be returned to you for correction and resubmission. Please note that the effective date of the NDC requirement is applicable to the claim processing date and not the date of service. Refer to the Claims Preprocessing Edits Claims Resolution Document at www.ibx.com/ediforms for information on claims submission resolution. If you have questions, please contact your Network Coordinator.
Note: Changes in NDC submissions went into effect January 1, 2009, for professional and home infusion providers and September 21, 2009, for institutional providers.
Refer to the January and September 2009 editions of Partners in Health Update on our archive page for more information about those changes. The January 2009 edition contains the complete list of unlisted and nonspecific drug codes.