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.
For more information please see attached PDF.