Get Ncpdp Form

Completing the Ncpdp Universal Claim Form online can streamline the process of submitting claims for pharmacy services. This guide provides clear and structured steps to help you fill out the form accurately and efficiently.

Follow the steps to complete the online form.

1. Click ‘Get Form’ button to obtain the form and open it in the editor.
2. Enter the recipient's 13 digit Medicaid ID in Field No. 1, which is required. You may also enter the group ID, patient name, and plan name, although these fields are not required.
3. Complete the 'Other Coverage Code' in Field No. 1 using values from the provided list, depending on your specific case.
4. For Field No. 6, enter the 7 digit Medicaid provider ID, which is required. Additionally, select the gender using the designated codes (1 for male and 2 for female).
5. In Field No. 12, enter the required prescription number and the value of '1' indicating an RX billing. Proceed to input the dates the prescription was written and filled in the specified format.
6. Fill out the quantity dispensed, days supply, and the National Drug Code (NDC) in Field No. 12 as well. These are required fields.
7. Continue filling any relevant optional fields, such as diagnosis codes, and use the specified values where applicable.
8. After completing all the required sections, review the form for accuracy. Finally, save your changes, download or print the completed form, or share it as necessary.

Start filling out your Ncpdp Form online today for a seamless submission experience.