There are many solutions for addressing J-codes.
- If you are a fully-insured client, your carrier has mechanisms in place to identify, reprice, and manage these drugs, as it helps hold down the cost of the medical plan. J-codes have been around for decades, and the insurers’ responses have evolved to address those billing practices.
- If you have a self funded plan and you use an “integrated administration” platform where a fully insured carrier, like Blue Cross/Blue Shield, United Healthcare, Cigna, Humana, and Aetna, administers your claims, you have the benefit of the platforms that the insurers use to keep their own costs down. They have developed these mechanisms over decades to help control their own costs.
- If you are on a non-integrated platform with a TPA and perhaps a PBM, then your vendor should be focusing on this.
If you want to understand your options and how your administrator addresses these codes, please reach out to one of our Client Managers.
