Drug Format

Pharmacies submit claims with the following Product/Service ID fields:

  • 11-digit National Drug Code (NDC) in the "Product/Service ID" field (407-D7)
  • Value "03" in the "Product/Service ID Qualifier” field (436-E1)

The NDC number submitted on the claim transaction must match the NDC number on the package or container dispensed.

The 11-digit NDC number is composed of the following three segments:

  • Labeler
    • 5-digit code assigned by the Food and Drug Administration (FDA) and identifies the drug manufacturer
  • Product
    • 4-digit code assigned by the drug manufacturer and identifies the specific product
  • Package
    • 2-digit code assigned by the manufacturer and identifies the package size

The correct format for pharmacy claim submission is an 11-digit number in a 5-4-2 format. Pharmacy providers must convert any other number, such as a 10-digit number in the 4-4-2, 5-3-2, or 5-4-1 format, before submittal. To correct the NDC place a leading zero in either the labeler code, product code, or package size code to conform to the 5-4-2 format.

Refer to the Multi-ingredient Compounds section for instructions on how to identify the NDC on a multi-ingredient compounds claim.