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Elizabeth M. Whitehorn, Director

Provider Notice issued 09/01/10

National Provider Identifier (NPI) – Prescriber ID and Primary Care Provider ID

 

To:​

Participating Pharmacies​
Date:​ September 1, 2010​
Re:​ National Provider Identifier (NPI) – Prescriber ID and Primary Care Provider ID​

 

On December 3, 2007, the department issued an informational notice to pharmacies regarding the department plans to require the NPI in the Prescriber ID field (411-DB). The purpose of this notice is to inform pharmacies that effective with claims received on or after September 15, 2010, the department will require the prescriber’s NPI. This requirement applies to electronic and paper claims. Pharmacies must also begin billing using the NPI in the Primary Care Provider ID Field (421-DL) when that field is populated. HFS will no longer allow the prescriber’s or Primary Care Provider’s DEA number, License Number, or HFS Legacy ID number.

 

Claims received on or after September 15, 2010, that do not contain the prescriber’s or primary care provider’s NPI will be rejected. Claims will be rejected with the following NCPDP error messages:

Prescriber ID Error Messages

EZ – Invalid Prescriber ID Qualifier
25 – Invalid Prescribing Practitioner Number

Primary Care Provider ID Error Messages

2E – Invalid PCP ID Qualifier
35 – PCP Invalid for Qualifier

Paper adjustments for any claims that required an NPI when submitted must contain the NPI in the Provider Number field.

If you have any questions regarding this notice, please contact the Bureau of Pharmacy Services toll-free at 1-877-782-5565, Option 7.

Theresa A. Eagleson, Administrator

Division of Medical Programs