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Elizabeth M. Whitehorn, Director

Provider Notice issued 12/03/07

National Provider Identifier (NPI) – Implementation for Pharmacies

To:​ Enrolled Pharmacies​
Date:​ December 3, 2007​
Re:​ National Provider Identifier (NPI) – Implementation for Pharmacies​

The Department of Healthcare and Family Services (HFS) continues to prepare for implementation of the National Provider Identifier (NPI) requirements. HFS announced an NPI contingency plan on May 14, 2007, and stated that HFS would soon begin to phase in, by provider type, the requirement of the NPI. The notice regarding HFS NPI contingency plan is posted at http://www.hfs.illinois.gov/all/051407_npi.html.

Effective with electronic and paper claims received on or after January 2, 2008, pharmacies must begin billing the Department using their NPI. Claims received on or after January 2, 2008, that do not contain the billing pharmacy’s NPI will be rejected. All electronic reversal, prior approval and eligibility transactions using the NCPDP 5.1 format must also contain the NPI beginning on this date. Pharmacies must submit their NPI in the Service Provider ID (201-B1) field. The Service Provider ID Qualifier (202-B2) must contain a value of 01 = NPI. Paper adjustments for any claims that required an NPI when submitted must contain the NPI in the Provider Number field.

The vast majority of enrolled pharmacies have reported their NPIs to the Department. Pharmacies who have not yet reported their NPI to the Department should do so as quickly as possible. Instructions for reporting NPI to the Department are included in the provider notice referenced above.

Prescriber ID is a required field (411-DB). If the prescriber’s NPI is available, the pharmacy should enter the prescriber’s NPI in this field. However, HFS will not require the prescriber’s NPI in the Prescriber ID field on January 2, 2008. For the present time, if the prescriber’s NPI is not available, pharmacies may continue to submit claims using the prescriber’s DEA number, License Number, or HFS Legacy ID number. HFS will, in the future, require the Prescriber’s NPI in this field. A provider notice will be sent notifying pharmacies of this requirement prior to implementation.

Any questions regarding this notice may be directed to the Bureau of Pharmacy Services at 877-782-5565, Option 7.

Theresa Eagleson, Administrator

Division of Medical Programs