multi-ingredient compound submission procedures place client logo here
TRANSCRIPT
Multi-Ingredient Compound Submission Procedures
Place Client Logo here
Submitting Multi-Ingredient Compounds
All compounds must be submitted using the Multi-Ingredient compound template
Contact your software provider if unsure how to submit a Multi-Ingredient compound template
SC Medicaid Bulletin
Magellan Medicaid Administration | 2
Submission Procedure for Compound Claims
There are three areas to complete when filing a compound claim1. Claim Segment
2. Compound Segment
3. Each line item
Magellan Medicaid Administration | 3
On Claim Segment
SUBMISSION CLARIFICATION CODE (NCPDP field # 42Ø-DK) = 8. PRODUCT/SERVICE ID QUALIFIER (NCPDP field # 436-E1) = 03. PRODUCT CODE/NDC (NCPDP field # 4Ø7-D7) Enter as
00000000000 COMPOUND CODE (NCPDP field # 4Ø6-D6) = 2. QUANTITY DISPENSED (NCPDP field # 442-E7) for entire product. GROSS AMOUNT DUE (NCPDP field # 43Ø-DU) for entire product.
Magellan Medicaid Administration | 4
On Compound Segment
COMPOUND DOSAGE FORM DESCRIPTION CODE
(NCPDP field # 45Ø-EF) COMPOUND DISPENSING UNIT FORM INDICATOR
(NCPDP field # 451-EG) COMPOUND ROUTE OF ADMINISTRATION
(NCPDP field # 452-EH) COMPOUND INGREDIENT COMPONENT COUNT
(NCPDP field # 447-EC) (Maximum of 25 ingredients) (See next slide for valid entries for compound segments)
Magellan Medicaid Administration | 5
Valid Entries for Dosage, Unit, and Route
Magellan Medicaid Administration | 6
Compound Dosage Form Compound Dispensing Unit Form Compound Route of Administration
01-Capsule
02-Ointment
03-Cream
04-Suppository
05-Powder
06-Emulsion
07-Liquid
10-Tablet
11-Solution
12-Suspension
13-Lotion
14-Shampoo
15-Elixir
16-Syrup
17-Lozenge
18-Enema
1- Each
2- Grams
3- Milliliter
1- Buccal
2- Dental
3- Inhalation
4- Injection
5- Intraperitoneal
6- Irrigation
7- Mouth/ Throat
8- Mucous Membrane
9- Nasal
10- Ophthalmic
11- Oral
12- Other/ Misc
13- Otic
14- Perfusion
15- Rectal
16- Sublingual
17- Topical
18- Transdermal
19- Translingual
20- Urethral
21- Vaginal
22- Enteral
For Each Line Item
COMPOUND PRODUCT ID QUALIFIER
(NCPDP field # 488-RE) COMPOUND PRODUCT ID
(NCPDP field # 489-TE); (i.e., NDC of each ingredient)
COMPOUND INGREDIENT QUANTITY
(NCPDP field # 448-ED); (i.e., quantity of each ingredient)
COMPOUND INGREDIENT DRUG COST
(NCPDP field # 449-EE); (i.e., ingredient cost of each ingredient)
Magellan Medicaid Administration | 7
Reminder
Contact your Software Provider if you are unsure where fields are located
Magellan Medicaid Administration | 8
Important Notes
The claim segment product ID (i.e., NDC) is a mandatory field when submitting multi- ingredient compound claims
A multi-ingredient compound claim must be submitted with eleven zeroes (00000000000)
A claim will reject if all zeroes are not submitted as the product ID
Magellan Medicaid Administration | 9
Magellan Medicaid Administration | 10
CLAIM SEGMENT
Field Name NCPDP Field # Comments
SUBMISSION CLARIFICATION CODE 420-DK Enter a value of “8”
PRODUCT CODE/NDC 407-D7 Enter a value of “00000000000”
COMPOUND CODE 406-D6 N/A
QUANTITY DISPENSED 442-E7 Enter quantity of entire product
GROSS AMOUNT DUE 430-DU Enter amount due for entire product
COMPOUND SEGMENT
Field Name NCPDP field # Comments
COMPOUND DOSAGE FORM DESCRIPTION CODE 450-EF N/A
COMPOUND DISPENSING UNIT FORM INDICATOR 451-EG N/A
COMPOUND ROUTE OF ADMINISTRATION 452-EH N/A
COMPOUND INGREDIENT COMPONENT COUNT 447-EC Maximum of 25 ingredients
LINE ITEM FOR EACH DRUG
Field Name NCPDP field # Comments
COMPOUND PRODUCT ID QUALIFIER 488-RE N/A
COMPOUND PRODUCT ID 489-TE Enter the NDC of each ingredient
COMPOUND INGREDIENT QUANTITY 448-ED Enter the quantity of each ingredient
COMPOUND INGREDIENT DRUG COST 449-EE Enter ingredient cost of each ingredient
Contacts
Magellan Medicaid Administration [email protected]
SCDHHS Janet Giles
[email protected] Brandie Crider
[email protected] Phone: 803-898-2876
Magellan Medicaid Administration | 11
SC