Michigan Requires Physician Individual NPI For All BCBS Claims

Caro, MI (March 31, 2015) - On March 30th, BCBS of Michigan and Blue Care Network issued a letter stating that effective April 1, 2015 they will begin validating the prescribing physician’s individual NPI on all Rx claims and Organization NPI’s will no longer be allowed.

BCBS is asking pharmacies to be sure the prescribing physician’s NPI number is accurate and included with every submitted Rx claim.

BCBS of Michigan also stated that if an incorrect physician NPI is identified during an audit after April 1st, that BCBS and BCN will recover the entire amount of the Rx payment.

SRS Addressed NPI Validation in March 2013

In PKon Rx v9.246, SRS implemented NPI validation in PKon utilizing two methods - one to verify if the NPI number exists in the NPPES NPI Registry and the second to verify if the NPI number is of the correct Type for a prescriber. New Store Parameters options were added regarding this NPI validation:

  • The first validation controls whether the prescriber’s NPI is validated during the Fill process. If validation is enabled (the default), warnings are displayed to the PKon user if the NPI does not match the NPPES NPI registry or is deactivated.
  • The second validation is a check of the physician’s NPI type. If enabled, warnings are displayed to the PKon user if the prescriber’s NPI is an organizational NPI. For billing purposes, prescribers should be identified by their individual NPI, not the organizational NPI for their practice or hospital.

About SRS Pharmacy Systems

An integrated Pharmacy Management software and systems provider servicing customers throughout the United States, SRS develops solutions that encompass the needs of community pharmacy. Key modules include Rx Scanning, RPh Verify, POS w/IIAS, electronic signature capture, Smartphone and web refills, Surescripts®, HIPAA, IVR, EDI inventory, Visa/MC/debit/credit card processing, LTC MAR printing, A/R, and thermal/laser printing. Services include web security, off-site backup, EFT payroll, health insurance, facility insurance and retirement benefits. SRS internally develops, supports and services all hardware, software, systems as well as manages pharmacy IT functions, allowing pharmacies to focus on their primary business. SRS customers have just one phone number to call for their pharmacy, business, and IT needs. One System, One Vendor, One Call.

SRS Pharmacy Systems Customer Support: (800) 673-6226