Sometimes pharmacies demand the physician's Drug Enforcement Administration (DEA) number for a prescription when the medication does not require the DEA number. The pharmacies say they need the DEA number for an insurance plan to pay for the prescription. What's a physician to do?
The Texas Department of Insurance (TDI) issued two bulletins to health insurers about this very situation more than 10 years ago. The TDI commissioner's message still stands:
- From the Dec. 28, 1992, bulletin - "The DEA has had numerous requests for DEA numbers because insurers are requiring those numbers for the purpose of reimbursement under insurance plans. The DEA does not endorse this use and does not have the available manpower to comply with all requests for these numbers.
"The DEA has asked this agency to … advise insurers that DEA registrants are not required by the DEA to provide their DEA numbers to insurance companies for the purpose of reimbursement under insurance plans."
- From the June 11, 1996, bulletin - "Any inappropriate use of Drug Enforcement Administration (DEA) provider numbers may be viewed as unfair claims settlement practices or result in violations of specific provider contracting laws. Please make any changes to your practices necessary to ensure your company's compliance immediately."
You can print out copies of the bulletins and give them to the pharmacies or the insurance plan.
You can discuss payment issues like this one with your colleagues and TMA staff by joining TMA's Billing and Coding Community, an online network open to TMA physicians and their office staff. TMA Online Communities have many features that help community members connect with each other, and they provide links to helpful resources, policy discussions, and solutions and ideas from your peers.
If you have questions, contact TMA Knowledge Center at (800) 880-7955 or email@example.com .
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