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Dear Prescriber:

Your immediate action will mitigate patient care delays, point of service claim rejections, and numerous pharmacy and Plan Sponsor calls to your office. Prescribers associated to HIPAA covered entities mustobtain a Type 1 Individual National Provider Identifier (NPI) and disclose it when needed for pharmacy claims. Failure to do so may be a HIPAA compliance issue after May 5, 2013.

Effective January 01, 2013, as outlined in Centers for Medicare and Medicaid Services (CMS) regulation[1] all Medicare Part D prescription claims submitted to CMS are to contain the prescriber’s Type 1 Individual NPI. Although you may not need a Type 1 Individual NPI to bill for your services, this identifier is needed for your patients who have Medicare Part D prescription benefits. Therefore, it is extremely important that you obtain this identifier and provide it to the pharmacy for prescription claims processing. You may want to simply have this identifier added to your prescription blank to avoid phone calls requesting this identifier. A Type 2 Organizational NPI that may belong to your practice or medical facility will not be sufficient to allow prescriptions for your patients to be billed to third party insurance carriers.

Please refer to the October 19, 2012 CMS Transmittal R2567CP which was directed to physicians. The sectionbelow is from page 14.

“Announcement About Medicare Participation for Calendar Year 2013”[2]

Recently, CMS published a final rule that requires virtually all prescribers, pursuant to certain relationships they have with covered organization health care providers, such as hospitals and group practices, to obtain an individual National Provider Identifier (NPI) and disclose it when needed for a pharmacy claim, if the prescribers have not already done so. Covered organization health care providers must direct prescribers to do so by May 6, 2013. The vast majority of prescribers already have individual NPIs. However, if you are one of the few prescribers who do not, we strongly encourage you to obtain an individual NPI as soon as possible. Obtaining an individual (Type I) NPI and disclosing it on each prescription you write will eliminate the need for follow-up with your office from pharmacies and payers. Obtaining an individual NPI is free of charge and takes approximately twenty (20) minutes. An individual NPI can be obtained on-line at the following link:

Obtaining a Type 1 Individual NPI requires only a few minutes of your time with no associated fees.

  • Logon to the NPPES website
  • Read the list of Information Required for Individual Providers and gather the required information.
  • Click the [Begin Application Form] button at the bottom of the web page.
  • You will be asked to select a User ID for the NPPES website.
  • Please read the instructions and create an appropriate User ID.
  • Note: Red text help will display if required data is not entered correctly.
  • When you complete a page press the [Next] button at the bottom of the page and continue until all pages of the application are completed.
  • Submit the application.
  • Your NPI will be provided in a return email in as little as one hour but within one business day.

Thank you.

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[1]42 CFR Parts 417, 422 and 423Medicare Program; Changes to the Medicare Advantage and the MedicarePrescription Drug Benefit Programs for Contract Year 2013 and OtherChanges; Final Rule

[2]