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Get NCPDP Billing Units right

Open jrlegrand opened this issue 10 months ago • 0 comments

Problem Statement

There are specific guidelines for figuring out Billing Unit per NCPDP at a NDC level.

Criteria for Success

EA, ML and GM assigned to each NDC as the billing unit, somehow validated.

  • [ ] Colonoscopy preps are 4000 g? mL? - no idea where to find that - might need to be hardcoded
  • [ ] Birth control is each pill not count of blister packs - may need to pull in DailyMed parts (Part 1 = 21 tabs / Part 2 = 7 tabs) to get this
  • [ ] Creams less than 1 g or 1 mL each are treated as eaches 24 PACKET in 1 CARTON (68462-536-70)  / .25 g in 1 PACKET would be 24 EACH, not 6 GM
  • [ ] Same for liquids - 6 POUCH in 1 CARTON (73043-005-02)  / 10 VIAL, SINGLE-USE in 1 POUCH / .4 mL in 1 VIAL, SINGLE-USE would be 60 EACH, not 24 mL
  • [ ] Don't include d (day) or h (hour) units 8 POUCH in 1 CARTON (0781-7144-83) / 1 PATCH in 1 POUCH (0781-7144-58) / 3.5 d in 1 PATCH would be 8 EACH, not 28 D
  • [ ] Spray bottles (fluticasone nasal) and inhaled MDIs (albuterol MDI) are counted by GM on the packaging (i.e. 16 GM for fluticasone / 8.5 GM etc for albulterol) but no idea how to get this aside from maybe hardcoding. Dailymed has it just buried in free text
  • [ ] Patches should be EACH not GM 5 PATCH in 1 CARTON (70000-0366-1) / 9 g in 1 PATCH should be 5 EACH not 45 GM

Additional Information

See attached file.

Billing-Unit-Imp-Guide-v4-0_202207.pdf

This table is a good starting point:

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jrlegrand avatar Feb 03 '25 19:02 jrlegrand