Transcript Use for Co-branded Presentations

Place Client
Logo here
Multi-Ingredient Compound
Submission Procedures
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 MultiIngredient compound template
SC Medicaid Bulletin
Magellan Medicaid Administration | 2
Submission Procedure for Compound Claims

There are three areas to complete when filing a compound claim
1. 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
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
Magellan Medicaid Administration | 6
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
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
Magellan Medicaid Administration | 10
Contacts

Magellan Medicaid Administration


[email protected]
SCDHHS

Janet Giles
 [email protected]
 Brandie Crider
SC

[email protected]
 Phone: 803-898-2876
Magellan Medicaid Administration | 11