Effective January 1, 2018, OptumRx enabled an enhanced prescriber DEA license scope of practice check at point of sale for all Schedule II-V controlled medication claims to prevent payment of scheduled medication claims from unauthorized prescribers. OptumRx has added submission clarification codes (SCC) to the enhanced DEA edit.

The enhanced DEA Edit overview, rejects encountered and pharmacy clarification codes (PCC):

The scope of practice check will validate submission of a valid, non-expired DEA prescriber license and then match the submitted prescriber’s full two alphabetic letters and 7 digit numeric license number string to the submitted controlled drug GPI. Successful validation of these two steps will allow the claim to proceed to adjudication. However, failure of the check will result in a hard reject at point of sale for any of the following reasons:

*Please see attached for more information.