Providers > Specialty Carve-Out

Welcome to LDI's Specialty Injectable Carve-Out Program.

LDI's Specialty Injectable Carve-Out Program is an innovative approach designed to control specialty injectable spending for LDI's self funded clients ("LDI Client").

It's easy to participate in this program. Simply sign and return the contract to LDI, and submit charges to your health plan as always. To ensure timely and maximum reimbursement, your office staff must do the following:

  • Before providing services to a patient covered by an LDI Client health plan, the provider must call the payer to confirm eligibility and benefits, just as the provider would do for other medical services. The LDI contact information should be on the patient's identification card.
  • When submitting the specialty injectable HCPCS codes on the CMS 1500, you will be required to enter the associated NDC number in Box 24J. You may have to speak with your practice management software vendor or billing service to ensure that these numbers will be formatted correctly for the electronic claims transfer.

LDI Specialty Carve-Out Program Resources

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If you have questions, please feel free to contact us at 314-652-2121, option 5, or 866-516-2121 or e-mail us at SpecialtyCarveOut@LDIRx.com.

We look forward to working with you.