| To: | Participating Pharmacies |
| Date: | December 28, 2016 |
| Re: | Pharmacy Claim Submissions with Incorrect Prescribing Provider Information |
This notice reminds pharmacy providers that it is the responsibility of the dispensing pharmacy as the Pharmacist-in-Charge to ensure that claims submitted to the Department reflect the correct prescribing provider’s unique 10-digit National Provider Identifier (NPI) number.
(l) “Pharmacist in Charge” means the licensed pharmacist whose name appears on a pharmacy license and who is responsible for all aspects of the operation related to the practice of pharmacy.
The Department has become aware of pharmacies submitting claims with incorrect prescribing provider information. Pharmacy providers should confirm and ensure accuracy of the “prescribing provider” information when submitting claims. It is extremely important that claims are submitted with the actual NPI of the prescriber who issued the prescription. The Handbook for Pharmacy Services (pdf) Chapter P-200 (P-202.5) states, “Pharmacies are expected to use diligence in obtaining a prescriber’s NPI for all prescriptions billed to HFS”.
The submission of incorrect prescribing provider information has resulted in unnecessary investigations into provider prescribing patterns, payment delays to pharmacies and unwarranted rejections of recipient prescriptions. It is the ultimate responsibility of the Pharmacist-in-Charge to oversee that claims submitted to the Department reflect the actual prescribing provider’s NPI.
In addition, repeat offender pharmacies may be viewed as violators of the False Claims Act resulting in potential sanctions.
Questions regarding this provider notice should be directed to the Bureau of Professional and Ancillary Services Pharmacy Billing Consultant at 877-782-5565.
Felicia F. Norwood
Director
