Taxonomy for Clinical Pharmacist Practitioner Added to NCTracks

Effective July 29, 2018, Clinical Pharmacist Practitioner (CPP) taxonomy code 1835P0018X will be added to allow in-state, border, and out-of-state individual Medicaid/Health Choice providers to enroll in NCTracks. CPPs will be authorized to act as an ordering, prescribing, referring (OPR) and/or rendering provider working under the direction or supervision of a licensed physician. Therefore, CPPs must complete the individual application (full enrollment) to bill for services rendered instead of the OPR Lite abbreviated application. 

Required licensure and certification for the CPP taxonomy are:

• Full and unrestricted license to practice as a pharmacist in North Carolina or the state in which the provider resides
• Full and unrestricted certificate to practice as a CPP in North Carolina

Out-of-state providers must be certified to practice as a CPP according to the rules of the state in which they practice.

The following enrollment requirements will apply:

• $100 application fee
• Credentialing and criminal background checks
• Re-credentialing every five years
• Manage Change Request (MCR) submission to update or end date the provider record

Note: The NPI Exemption List deadline is August 31, 2018. CPPs are encouraged to begin the enrollment process on July 30, 2018.

Per 21 N.C.A.C. 46.3101, a CPP is approved to provide drug therapy management, including controlled substances, under the direction or supervision of a licensed physician only.

If a claim is submitted with a CPP's NPI and taxonomy as the billing provider, the claim will be denied with Explanation of Benefits (EOB) 01877 - PROVIDER IS NOT AUTHORIZED TO ACT AS A BILLING PROVIDER.