As previously communicated by CVS Caremark®, Provider must use the Prescriber’s valid and active NPI. It is not acceptable, at any time, to utilize an invalid NPI which does not represent an individual prescriber (Type 1 NPI). The following requirements regarding prescriber identification apply to all claims (Commercial, Medicaid and Medicare Part D):
• The prescriber is valid and active and authorized by state and federal regulatory agencies to prescribe medications
• The prescriber has a Type 1 NPI which must be submitted on the prescription claim. No other form of prescriber identification will be accepted. Any claim submitted with an invalid NPI will reject, but the appropriate SCC value can be used to override the rejection. This requirement is being applied to all claims since most health care providers are required to obtain and use an NPI as a standard identifier.
• For controlled substance prescribing, a prescriber must have an active DEA identifier in good standing and have the authority to prescribe a controlled substance in a given DEA drug class schedule (2,2N,3,3N,4,5), but the appropriate SCC value can be used to override the rejection.
Please see attached for additional information.