Date: May 22, 2019
To: Enrolled Pharmacies
Re: Prescriber National Provider Identifier (NPI) Requirements Effective July 1, 2019
This informational notice applies to Department fee-for-service pharmacy claims and not HealthChoice Illinois managed care pharmacy claims.
November 9, 2018 and December 28, 2018 informational notices outlined the Department’s requirement that all prescriptions for participants, whether under fee-for-service or managed care, be written by an enrolled prescriber. The Department will begin enforcing this requirement with pharmacy claims submitted beginning July 1, 2019. Pharmacy claims with a prescriber who is not enrolled with the Department will be denied for payment with rejection message, “Prescriber Not Enrolled.”
This notice serves to inform pharmacies that the Department my provide a one-time override for medications for participants who are receiving prescriptions from a non-enrolled prescriber. Prescribers should begin the enrollment process via IMPACT if they have not already done so and wish to continue to see participants enrolled in the Department’s medical programs. Otherwise, this override will allow time for the participant to make arrangements to see another prescriber.
An override may be requested by calling a pharmacy billing consultant at 877-782-5565. Please note, these overrides cannot be obtained from the prior authorization line. Questions regarding this notice may also be directed to a pharmacy billing consultant at the telephone number above.