Some procedure codes require NDC codes for insurance claims - this guide will explain how to add it, and when to add it.

Adding an NDC Code

To add the NDC code, go to the Code Encounter or Edit Encounter screen for an encounter, and find the "Procedures" tab. 

It will contain boxes for codes like above, and when you add a code, a "More" box will appear on the right.  If you click "More", extra options as shown above will appear.  You may add the NDC code and, if necessary, a note with the name of the drug.

What Error Appears when I was supposed to add an NDC code, but didn't?

If you ever receive a claim rejection that says something like "Sub-element SV101-07 is missing", this means that your claim needed an NDC code.  

 When do I need to add an NDC code to a procedure?

You will need to add an NDC code to a procedure if the procedure code used is one for any form of drug administration.

When do I need to add a note to a procedure?

If the procedure code is for a nonspecified drug, the NDC code is used to clarify exactly what drug was administered - but insurance companies require a note describing the drug (preferably by name).  For example, the code J3490 means "Unclassified Drugs", and will need a Note description for clarification.  Any time a drug has something like "Not otherwise specified", such as J7599 (Immunosuppressant not otherwise specified), you need a descriptive note.    If the procedure code describes thoroughly and completely what the drug administered is, you will not need a a notecode, and you may get an error such as "Sub-element SV101-07 is used. It should not be used when loop 2410 is used and HCPCS code from SV101-02 is not from external code list - Not Otherwise Classified Codes (NOC)."  This means you must go delete the note and resubmit.

Processing Insurance Over-Payments

 Sometimes, an insurance company will over-pay for a claim, and request a refund later.  You will need to record the refund, adjust the encounter to account for the refund, and send the insurance company the refund.

Recording the Refund in nAble

To record the refund, you will enter it as a new payment (in the PM top navigation menu, select Payment, then, in the "Post New Payment" section of that page, select "Insurance Payment".  You will then need to enter the following information:

1. The Insurance Company Name
2. The method you are using to pay the insurance company
3. Any information that payment form needs (Check #, transaction ID, etc.)
4. The total amount refunded AS A NEGATIVE AMOUNT (If you are refunding $100, enter -100.00)
5. The payment date
6. A note describing the payment as a refund

Next you will have options for selecting who to apply the payment to - select the patient whose claim is being refunded.  Then, select the encounter the claim was for.  It may not be listed if the encounter was considered complete and "Closed", so be sure to check the "Closed" list if necessary.

It will then take you to the "Encounter Charges" screen, where you can update the payment accordingly.  Typically, you will either be asked to adjust off the charges or transfer them to the patient. In the example case here, Aetna told us to adjust off $200, so we will increase the adjustment amount by $200 and apply a -$200 payment, so that the insurance company ultimately adjusts off $200, pays $50 and the patient owes $0.

After this, click "Apply Payment", and the Amount Applied should match the payment amount, leaving $0 in credit left.  Then, you can close the payment, and everything will be correct!

Lastly, send the insurance company the refund - that way, your records will match reality.  Then you're done!

To manage the clinic's accounts, go to the PM left sidebar -> Settings -> Clinic settings -> Accounts.

Here you will find a list of all existing accounts, their capabilities, and some options to add or edit accounts.

Click the "Edit" button on the account you wish to edit, and you will be taken to the "Edit User Account" screen.  

Any time an account is missing access it needs, or has access it should not have, this is where you can fine-tune their access to their specific needs.