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Date: August 5, 2019
To: Health Plan of San Joaquin (HPSJ) All Providers & Facilities
From: HPSJ Claims Department
Subject: DHCS Encounter Requirement – NDC Required   
Business: Medi-Cal Managed Care

Health Plan of San Joaquin (HPSJ) was recently informed the California Department of
Health Care Services (DHCS) is requiring the National Drug Code (NDC) be listed with any associated Physician Administered Drug (PAD) as part of the encounter data reporting process.

In line with this DHCS requirement –

  • Effective July 1, 2019, all claim submissions, regardless of the date of service(s) on the claim, should include the NDC when billing drug-related codes.
  • If claims are submitted without the required NDC:
    a) The claim line will deny
    b) A resubmission of a Corrected Claim will be required [see Corrected Claim Provider Alert(s)]
  • In the near future, claim submissions will start being rejected at the clearinghouse level to ensure clean, reportable claims are processed.

These changes will ensure each claim submission will reconcile with each encounter submission to DHCS.

If you have any questions, please contact our Customer Service staff at 209.942.6320

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