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CMS requires an individual NPI on all prescriptions for members covered under Medicare Part D
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Supported by the Patient Protection and Affordable Care Act of 2010 and as
required by the Centers for Medicare & Medicaid Services (CMS), prescribing
providers must include their individual (Type 1) National Provider Identifier
(NPI) on all prescriptions for Medicare Advantage HMO and PPO members who are
covered under the Medicare Part D program.
Prescriber identifiers are valuable Part D program safeguards. These
identifiers are the only data on Part D drug claims to indicate that legitimate
practitioners have prescribed drugs for Medicare enrollees. Without valid
prescriber identifiers, efforts made by CMS to determine the validity, medical
necessity, or appropriateness of Part D prescriptions and drug claims may be
limited.