by Jared Staheli
June 18th, 2015
The DME MAC and the A/B MAC (B) are billed on the ASC X12 837 professional claim format or if permissible Form CMS-1500.
The A/B MAC (A) (including the A/B MAC (HHH)) is billed on the ASC X12 837 institutional claim format or if permissible Form CMS-1450.
Note that the ASC X12 formats support reporting of the CMNs in the FRM segment
The National Council for Prescription Drug Programs (NCPDP) Telecommunications Standard Version D0 and Batch Standard 1.2 is the HIPAA standard for electronic retail pharmacy drug claims and related coordination of benefits (COB).
This standard will be used by all DME MACs that process retail pharmacy drug transactions. All other claims submitted to the DME MCA by pharmacies, other than retail pharmacy drug claims, must be sent in the ASC X12 837 professional claim format.