Precluded Prescriber
In accordance with CMS Final Rule CMS-4182-F, CVS Caremark will begin rejecting any claims prescribed be an individual on the Preclusion List effective April 1, 2019. Claims will reject with the following or similar:
Reject 929: <<Prescriber ID is precluded>>
There is no override for this reject. Impacted Part D Enrollees that have concerns or need assistance finding a new prescriber should contact Medicare’s toll-free customer care operations at 1-800-MEDICARE (1-800-633-4227).
Background: Effective January 1, 2019, CMS began publishing a list of precluded prescribers. This list includes prescribers who meet one of the following conditions:
• Prescribers are currently revoked from Medicare, are under an active reenrollment bar, and CMS has determined that the underlying conduct that led to the revocation is detrimental to the best interests of the Medicare program; or
• Have engaged in behavior for which CMS could have revoked the prescriber, individual or entity to the extent applicable if they had been enrolled in Medicare, and CMS determines that the underlying conduct that would have led to the revocation is detrimental to the best interests of the Medicare program. Such conduct includes, but is not limited to, felony convictions and Office of Inspector General (OIG) exclusions.
CMS requires Medicare Part D plans to reject pharmacy claims prescribed by an individual on the preclusion list effective April 1, 2019.
For additional information go to:
https://www.cms.gov/Medicare/Provider-Enrollment-and-Certification/MedicareProviderSupEnroll/PreclusionList.html