Our understanding of the 2410 LIN situational rule is an NDC is required only when government regulation mandates the reporting of the NDC or the provider/submitter chooses to send it. Based on this, a commercial payer may not require or consequently deny payment of an 837P/I claim because an NDC code was not reported.
As a commercial payer we are struggling with understanding the purpose of the situational rule to only require it when government regulation mandates it. If a commercial payer does need an NDC in order to adjudicate the claim correctly (home infusion therapy is an example), and the 837I/P claim does not contain it, they are forced to pay the claim incorrectly. If our understanding of the situational rule is incorrect, please let us know. Also, can the workgroup provide some background regarding the reason this situational rule excludes commercial payers from requiring an NDC?
There has been no formal request made to ASC X12N WG2 for a business need beyond what is currently defined in the situational rule.
Please refer to RFI 1512 for more information about receiving a transaction that is not compliant with the specified implementation guide.
The workgroup recommends submitting a request through the DSMO process at http://www.hipaa-dsmo.org.
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