Effective this Friday, Oct. 1, fee-for-service pharmacy claims must include prescribers National Provider Identifier (NPI) and the prescribers must be actively enrolled with Florida Medicaid in accordance with Title 42, Code of Federal Regulations, Section 455.410(b) or your claims will be denied.
Beginning in March, Florida Medicaid, a division of the Agency for Health Care Administration, began phasing in error codes in preparation for the Oct. 1,2021 implementation. This is being implemented to further protect the Medicaid program from fraud.
Effective March 2, 2020, pharmacies began receiving National Council for Prescription Drug Programs (NCPDP) error code 25 Missing/Invalid Prescriber ID at the point-of-sale when an FFS claim was submitted with the Florida Division of Health (DOH) license number for a prescriber with an active NPI.
Effective June 25, 2021, pharmacies began receiving NCPDP error code 71 stating Prescriber ID is not covered at the point-of-sale when a fee-for-service claim is submitted with the Florida Department of Health license number for a prescriber without an active NPI. Active NPI means that the prescribers NPI is known to Florida Medicaid.
Also, effective June 25, 2021, pharmacies began receiving NCPDP error code 889 stating Prescriber Not Enrolled in State Medicaid Program at the point-of-sale when a fee-for-service claim is submitted with the NPI number for a prescriber who is not enrolled with Florida Medicaid.
During this period of transition, providers have been able to get those denials temporarily overridden. However, that no longer will be the case as of Oct. 1, 2021.
It’s important to note that the requirement does not pertain to pharmacists, state-authorized pharmacy interns, and qualified pharmacy technicians who administer pediatric and COVID-19 immunizations under the Public Readiness and Emergency Preparedness (PREP) Act.
Pharmacy claims must continue to identify the administering pharmacist by Florida pharmacist license number submitted as the prescriber ID in the NCPDP field 411-DB for the following vaccines and immunizations covered under the PREP Act, in accordance with or identified by the Advisor Committee on Immunization Practices
- COVID-19 Vaccines
- Influenza Virus Vaccines
- Viral/Tumorigenic Vaccines
- Biologicals
NPIs ensure that each provider has one identifier that’s used in transactions across all health plans. The Centers for Medicare & Medicaid produced this booklet to explain the ins and outs of NPIs.
The Health Law Offices of Anthony C. Vitale represents pharmacies as well as providers. For more information contact us at 305-358-4500 or email info@vitalehealthlaw.com.
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