Effective January 1, 2014, in accordance with Federal Regulations at 42 CFR Subpart E, the Division of Medicaid (DOM) requires that all ordering and referring physicians or other professionals providing services under the State plan or under a waiver of the Plan be enrolled as participating providers. Prescribers who write prescriptions for Medicaid beneficiaries must be enrolled as Medicaid providers.
DOM began implementation of this requirement effective January 1, 2014, and the current processes for pharmacy point of sale claims are noted below:
- Prescription claims with a date written on and/or after January 1, 2014, must be written by a prescriber who has a valid and active MS Medicaid enrollment which is verified by the prescriber’s individual NPI number.
- After January 1, 2014, first time claims received for non-Medicaid providers “with a date written” on or January1, 2014, post NCPDP Reject ’56-Non Matched Prescriber ID’ with the accompanying message ‘FEDERAL LAW REQUIRES THAT ALL MEDICAID PRESCRIBERS ARE ENROLLED AS A MEDICAID PROVIDER. NPI SUBMITTEDON THE CLAIM MUST BE THE ACTUAL PRESCRIBER ON THE PRESCRIPTION (RX); ANY OTHER IS CONSIDERED FRAUD’.
- If the Prescriber’s NPI number is not enrolled with Medicaid as a valid and/or active provider, that prescriber will have a grace period of 90 days to enroll.
- If these prescribers do not enroll during their 90 day grace period, then on the 91st day and thereafter their Medicaid
prescription will deny.
- Pharmacy claims will begin denying on November 1, 2014, if the Prescriber is not an enrolled Medicaid provider.
To prevent denial of the rendering provider claims AND to ensure access to pharmacy services for our Mississippi Medicaid beneficiaries, please make sure that the prescribing provider’s individual NPI is noted on the prescription and all claims. It is required that all individual prescribing providers must be actively enrolled with DOM.
Please direct all questions related to enrolling as a Medicaid Provider Services to Xerox toll-free at 1-800-884-3222.