Beginning Jan. 1, 2013, CMS will require NPI numbers for Part D prescription drugs. From Jan. 1 until May 5, prescribers can be identified by either an individual Type 1 NPI or a group/organization Type 2 NPI for electronic claims processing. Beginning May 6, only Type 1 NPIs will be allowed. Recognizing the enormity of remediating a multitude of prescriber records on a national level, Health Market Science (HMS) has developed a road map beginning with its Prescriber Eligibility that validates prescriber identifiers against the company’s MasterFile prior to claim submissions.

Prescriber Eligibility offers retrospective, as well as real-time solutions. Retrospectively, Prescriber Eligibility offers claims analysis to quantify Type 2 NPI usage so that integration services can append the prescriber data record with the valid Type 1 NPI identifier in preparation for the May 6 compliance date. At the point of sale, Prescriber Eligibility offers a real-time solution by providing warning messages when an organization Type 2 NPI is used. This step is designed to help pharmacists understand the impending change and encourage the movement to Type 1 NPI in advance of May 6.

“Currently, many prescribers use NPI numbers that are associated with a healthcare organization,” says Jeff Klein, COO of HMS. “During the grace period it will be imperative for pharmacies to understand which of those prescribers are in their system and how to transition the records.”