Videl Nelson, Lead Consultant

Struggling with Claim Denials due to Obsolete NDCs?

Has your organization received denials of claims due to the National Drug Code (NDC) on the claim being deemed as an obsolete National Drug Code by the insurance company? When a claim is sent to the payor with a drug on it that has an obsolete NDC associated with it, typically the payor will deny the entire claim due to an obsolete NDC. This causes more rework for your organization’s billing office and/or PFS team. Dispensing of drugs that have an obsolete NDC can negatively impact billing and your organization’s denial rates.

Taking a step back, what do we mean when we talk about obsolete NDCs? An obsolete NDC means that the manufacturer of the drug no longer makes the drug in that form and that the given National Drug Code (for that drug) has been replaced or discontinued by the manufacturer. But just because a drug’s NDC is deemed as obsolete does not necessarily mean that the drug is expired. In this context, an expired drug is a drug that has not been used in a certain time period since it was manufactured, and the manufacturer states that it will not certify the effectiveness of the drug after the specified date. In other words, an obsolete drug can still be an effective drug that is clinically appropriate and still has “shelf life.”

As an organization, you may be asking how you can better track and reduce this type of denial to positively influence your billing and denial rates. With Softek’s Formulary Compliance control, the pharmacy team is given visibility into the volume of drugs that have obsolete NDCs tied to them within their Millennium system. Having this type of visibility allows the team to quickly identify the pharmacy bill items causing those claim denials, making the billing process smoother downstream. In addition to our Formulary Compliance control, we have a Claims Denial control, which can be used by the business office and/or PFS to track all the claims denied due to the various “invalid NDC” reasons. This provides better insight into what needs to be addressed to reduce the number of denials your organization is experiencing. Check out all of our tools.

What does Softek® do?

Softek’s mission is to help hospital systems maximize their investment in Oracle Cerner Millennium®. We do this by providing innovative software solutions and consulting services that can achieve more together than either can alone.

At Softek, our team of innovators and software developers brings expertise beyond the ordinary to every client. Our experts are involved with Oracle Cerner Millennium® hospitals throughout the country, consulting clients so they can optimize system performance and revenue integrity.

Softek delivers a full suite of consulting services and software solutions to assess and optimize EMR system performance, including revenue cycle integrity and patient accounting.

Softek was awarded 2021 Best in KLAS for Revenue Cycle Optimization.

Let’s talk about how you can get the most out of your Oracle Cerner Millennium® system.