CMS Issues Final Rule Requiring Use of NPI Numbers

Pharmacies filling prescriptions for covered Part B items such as durable medical equipment, prosthetics, orthotics, and supplies (DMEPOS) will need to ensure their systems are transmitting both the pharmacy NPI and the prescriber's NPI in claims submissions.

On April 27, that will require health care providers and suppliers to use their National Provider Identifier (NPI) when submitting Medicaid or Medicare claims as well as when they enroll in the Medicare and Medicaid programs. The new rule, Medicare and Medicaid Programs; Changes in Provider and Supplier Enrollment, Ordering and Referring, and Documentation Requirements; and Changes in Provider Agreements, implements Section 6402(a) of the Affordable Care Act (P.L. 111-148).  CMS published an interim final rule with comment period in May 2010 (75 FR 24437) with a July 2010 effective date. 

, the new rule ensures that "...only qualified providers and suppliers can order or certify certain medical services, equipment and supplies for people with Medicare." Pharmacies filling prescriptions for covered Part B items such as durable medical equipment, prosthetics, orthotics, and supplies (DMEPOS) will need to ensure their systems are transmitting both the pharmacy NPI and the prescriber's NPI in claims submissions. The final rule is effective June 26, 2012