11/13/2015 Dear Pharmacy Network Provider, Beginning January 1, 2016 all claims submitted to PerformRx must be submitted with a valid Prescriber National Prescriber Identifier (NPI) number. This is a result of MACRA Legislation which was passed April 16, 2015. Currently PerformRx accepts claims submitted with only a Drug Enforcement Agency (DEA) identifier for select customers. Beginning January 1, 2016, claims submitted with only a DEA number and identifier will deny at point-of-sale and reject with error 434 (Valid Prescriber Type 1 NPI Required), requiring the pharmacy to submit a valid Prescriber NPI number and qualifier.

Effective January 1, 2016, CMS requires that claims for covered Medicare Part D drugs must include active and valid prescriber NPIs; claims for both new prescriptions and refills without a qualifier for NPI and a valid NPI number will reject.

Inside this issue:

All prescriptions must be submitted with an active, valid NPI number for the prescribing physician.