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NDC Claims Info

NDC Numbers & Insurance Claims

PD-Rx has put this information together to provide you a better understanding of NDC numbers, insurance companies, and their claim forms. In order to help you with the filing and the registration of our NDC number on the insurance claim form, you must first recognize that the Food and Drug Administration (FDA) issues a 10 digit identification number for each and every product available on the market. The first group of numbers in the NDC code identifies the manufacturer, repacker, or private labeler. As with PD-Rx, our NDC number for Amoxicillin 500mg 30 Capsules is # 55289-020-30. The first set of numbers -55289- identifies PD-Rx and our location.

In many cases, some of the earlier manufacturers where given a 4-digit identification number for the first set of numbers. For example, ABC Manufacturer might have a product with an NDC of 1111-8888-10. Again, please note both a five and four digit number has been used to identify the company in the first set of numbers.

The second set of numbers in a NDC number is used to identify the product that has been labeled and distributed by the manufacturer, repackager, or private labeler. As you will note with PD-Rx's NDC for Amoxicillin (-020-) as listed above, a three-digit number has been used to identify this product. Some NDC numbers will be listed with a four-digit number as with the example above (-8888-).

The last set of numbers in a NDC number is used to identify the number of tablets, capsules, ounces, milliliters, etc. contained in the final retail container. Please note that the last two digits in the PD-Rx NDC number for the Amoxicillin is –30, which indicates to PD-Rx and the FDA that there are 30 capsules in that bottle for distribution as labeled. With the example medication, the NDC number lists (-02) to represent a tubex containing 10ml per unit as labeled and distributed. This means that the manufacturer has selected (-02) to represent 10ML w/ their FDA filings, so any medication from ABC Manufacturer that comes in 10mL per unit would have (-02) as the third set of numbers in the NDC.

Below lists the NDC numbers side by side:

PD-Rx 55289-020-30
ABC Manufacturer 1111-8888-02

The PD-Rx NDC number has been listed as a 5-3-2 combination and the ABC Manufacturer number has been listed as a 4-4-2 combination. In order for the insurance companies to create a universal form for the NDC numbers, may of them have elected to use the following format listed below.

NDC # _ _ _ _ _ - _ _ _ _ - _ _
                (5)            (4)        (2)

Which is comprised of a combination of the two different NDC numbering systems used by the FDA and listed as a 5-4-2 numbering sequence or combination. With this format, the insurance company will be looking for an 11-digit number. If you were to list the PD-Rx number on this type of universal format, you would be required to add a “0” within the second number sequence in order to complete the four number slots as indicated by the insurance form. The insurance company would require the “0” be placed in front of the –020- from the PD-Rx NDC number.

The PD-Rx NDC number would look like this as listed on the universal claims form:

NDC # 55289-0020-30
                (5)     (4)    (2)

The ABC Manufacturer NDC number “1111-8888-02” would look like this on the universal claims form:

NDC # 01111-8888-02
               (5)      (4)    (2)

As with the ABC Manufacturer NDC number the “0” has to be added to the first sequence of numbers in order to fill the insurance form as so indicated by a 5-4-2 open numbering slot. (11 digits) Some manufacturers will even have a (5) (4) (1) configuration issued by the FDA, and if this is the case the “0” would be added to the last segment to make this a two digit character for the insurance form.

This would complete the form as requested by the insurance carrier, but do not let them tell you that the NDC is wrong. And that you need to have an 11 digit NDC number from the manufacturer, the FDA only issues a 10 digit number. The 11-digit configuration, a 5-4-2 combination, is a development of the insurance markets not the FDA. You will not find an 11-digit NDC number on any of our products. Our NDC numbers are listed with First Data Bank, Red Book, Medispan and many other publications. If you wish to verify any NDC number, please feel free to contact our customer service department at any time.

Call toll free 1-800-299-7379, or fax 1-800-370-3556.







 




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