On April 16, 2015 the Medicare Access and CHIP Authorization Act of 2015 (MACRA) was signed
into law. Section 507 of MACRA amends Section 1860D-4(c) of the Social Security Act by requiring
that pharmacy claims for covered Part D drugs include an active and valid Type 1 National
Provider Identifier (NPI). Beginning January 1, 2016 a Part D sponsor cannot pay a claim that does
not include an active and valid prescriber NPI.
Effective January 1, 2016 pharmacies must submit claims with an active and valid
prescriber NPI – the SCC 49 value will be discontinued. The legislation invalidates the use
of Submission Clarification Code (SCC) value 49 "Prescriber does not currently have an
Active Type 1 NPI.”
Claims without the NPI will reject with reject code 34 - M/I Sbm Clarification Cde
If you have questions, please call the OptumRx Help Desk anytime:
- UnitedHealthcare Medicare Prescription Drug Plans : 877-889-6481
- UnitedHealthcare Medicare Advantage Prescription Drug Plans: 877-889-6510
- All other plans: Use Toll-Free-Number on Member’s ID Card
Please distribute immediately.