TMA and a Texas pharmacy chain have teamed up to fend off headaches for you and for your patients who need their Medicare and Medicaid prescriptions filled.

That's because H-E-B - like many other pharmacies - has adopted a policy of not filling Medicare Part D prescriptions unless the pharmacist has access to the prescribing physician's national provider identifier (NPI). All physicians who file claims electronically now are required to have this federally mandated identifier. 

The headache: Pharmacy staff will search the H-E-B database or look on the prescription for the physician's NPI. If the NPI isn't available from either of these sources, the pharmacy likely will call the physician to get it. And because pharmacy claims are adjudicated in real time, if the pharmacy can't get the NPI, it won't file a claim and may look to the patient for payment. At best, the patient could face a long wait at the pharmacy counter; at worst, the patient's treatment regimen could be interrupted if he or she is unable to pay.

The pill: TMA has updated the TMA NPI Look-Up Tool with Texas physicians' NPIs gleaned from the National Plan and Provider Enumeration System public NPI database. TMA shared these numbers with H-E-B on a one-time basis so that it can fill the gaps in the pharmacy's database. This will save H-E-B pharmacists from having to contact physicians for the NPI, physicians from having to respond to the pharmacy request, and patients from having their prescription not filled for lack of an NPI. TMA is currently working on similar projects with other Texas pharmacies.

In the short term, physicians may put their NPI on all prescriptions to avoid this sort of problem with other pharmacies and other payers. And remember, TMA members can use the look-up tool to find another member's NPI if needed, e.g., when filing claims involving referrals.

Don't have your NPI yet? You must apply now , or your electronic claims will be rejected. Once you have a number, be sure to add it to the TMA look-up tool database online or by calling the TMA Knowledge Center at (800) 880-7555.

CMS posted answers to frequently asked questions on its Web site.


Action , June 16, 2008

Last Updated On

June 23, 2010