Prescribers Not Enrolled in Medicaid - Updated

The Affordable Care Act established a new rule that prohibits Medicaid and Children’s Health Insurance Programs [such as N.C. Health Choice (NCHC)] from paying for prescriptions written by prescribers who are not enrolled in Medicaid and NCHC programs.

On January 1st, 2013, pharmacy providers began to receive a message at point-of-sale for prescriptions written by prescribers not enrolled in the Medicaid program. The edit, 00951, states “M/I PRESCR ID - NO ID ON FILE� with EOB 02951 message “PRESCRIBER NPI NOT ON FILE. CONTACT PRESCRIBER AND REFILE WITH CORRECT NPI.� Currently claims pay on this edit.

Important: Claims will deny starting on November 16, 2014. This will hold true for originals and refills.

(This is an update to the Oct 17 posting)