Claim edit: Invalid NDC format

Stedi now rejects 837P professional and 837I institutional claims that contain a National Drug Code (NDC) with an invalid format.

How the edit works

National Drug Codes (NDCs) are unique identifiers for drugs or biologics regulated by the U.S. Food and Drug Administration (FDA).

A provider can list an NDC in one or more service lines of a claim to get paid for drugs administered during care.

Payers use NDCs in claims to determine the correct reimbursement amount for these drugs or to apply drug rebates.

HIPAA-adopted X12 standards require that all NDCs in a claim be 11 digits. If a claim includes an NDC that’s not 11 digits – such as an NDC that’s too short or too long – the payer may reject the claim. This can delay payment for the provider.

This edit – the industry term for an automated validation rule – catches the issue before the claim reaches the payer.

Rejection errors

If you submit a claim that fails the edit using Stedi's Claim Submission API endpoints, you'll get back an error response in real time. The response includes details in the errors array:

{
  "errors": [
    {
      "code": "33",
      "description": "Invalid National Drug Code (NDC). Service line 1 contains an invalid NDC value: 0002606351. NDCs must be 11-digits without any spaces or hyphens and valid per FDA records. Correct and resubmit.",
      "followupAction": "Please Correct and Resubmit"
    }
  ]
}

If you submit a claim that fails the edit using SFTP, Stedi will reject the claim with a 277CA claim acknowledgment. The acknowledgment will include a related claim status category code, claim status code, and error message:

STC*A7>218*[DATE]*U*[AMOUNT]********Invalid National Drug Code (NDC). Service line 1 contains an invalid NDC value: 0002606351. NDCs must be 11-digits without any spaces or hyphens and valid per FDA records. Correct and resubmit.~

Tip: How to handle 10-digit NDCs

The FDA has previously published 10-digit NDCs. X12 standards still require these NDCs to be 11 digits in claims.

Regardless of length, all NDCs have three segments: a labeler, a product, and a package code. In 11-digit NDCs, these segments must be 5, 4, and 2 digits respectively.

To convert a 10-digit NDC to an 11-digit NDC, add a leading zero to whichever segment is short.