by Jared Staheli
July 9th, 2015
Carriers and/or Program Safeguard Contractors shall apply all Local Coverage Determination (LCD) policies and National Coverage Determination (NCD) policies to the administration and no-pay drug code lines on the CAP claims.
Should it be determined that a drug administration or drug code service line does not meet the requirements of the LCD, the carrier shall follow current processes to determine how to adjudicate the related services.
If appropriate, the carriers shall include messages on the MSN and RA to indicate which LCD was applied.
The carriers shall also apply all regular edits to the administration and no-pay drug lines and send appropriate denial messages.