M119Remark Code (RARC)Active
M119 Remark Code - NDC Issues Explained
The M119 remark code indicates that the National Drug Code (NDC) associated with the billed service is missing, incomplete, invalid, deactivated, or withdrawn. This remark supplements an adjustment already noted by a Claim Adjustment Reason Code, providing specific insight into the NDC issue that led to the adjustment.
How It Relates to the Denial
The M119 remark code typically accompanies adjustment reason codes related to drug billing, signaling that the NDC does not meet the required criteria. It serves to clarify why a claim was adjusted due to issues with the NDC provided on the claim.
Common Scenarios
1A pharmacy billed for a prescription medication but received a denial that included a Claim Adjustment Reason Code indicating a payment adjustment due to billing errors.
→ The M119 remark code suggests that the NDC for the medication was either missing or invalid, which is why the claim was adjusted.
2A hospital outpatient service was billed for a chemotherapy drug, and the remittance indicated that payment was denied due to an incomplete NDC.
→ The appearance of M119 indicates the need to verify the completeness and validity of the NDC provided, as this is crucial for proper reimbursement.
3A claim for a vaccine was submitted, but the remittance returned an adjustment for the claim along with an M119 remark code.
→ This implies that the NDC for the vaccine was either deactivated or withdrawn, which directly impacted the payment adjustment.
What to Do
- Verify the NDC submitted on the claim for accuracy and completeness.
- If the NDC is missing, obtain the correct code and resubmit the claim with the complete information.
- Check if the NDC has been deactivated or withdrawn and replace it with a valid code if necessary.
What to Check
- The claim form to confirm the NDC listed was accurate and complete.
- The payer's NDC database or list to ensure the code is currently active.
- Any updates from the manufacturer regarding the status of the NDC.