Guidance for Prescribers Not Enrolled in Medicaid

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.

As previously announced, as of November 16, 2014, claims for original and refill prescriptions written by a provider not enrolled in Medicaid will deny. Pharmacy providers 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.�

For guidance on the options available to ensure recipients have access to medications, see the document link below. Also listed below is the link to Provider Enrollment for the Medicaid program.