Student NPI Not Covered

[pharmalt82]

Advertisement - Members don't see this ad

I am seeing a lot of Rxs being rejected by insurance companies because the NPI is not covered. I look up the NPI in the registry and it always says 'Student.' If there is no attending physician's NPI number and I can't get in touch with the hospital to find out the attending's name and NPI, what is the solution?

 

[waiter]

It is not actually a prescription if it was signed by a student. You need a new prescription from a valid prescriber

 

[Ackj]

It is not actually a prescription if it was signed by a student. You need a new prescription from a valid prescriber

I have had similar rejections from residents who are valid prescribers. There should always be someone available at the hospital you can contact. Even if it isn't the resident or the attending, somebody from that team should be available to get you a supervisor/attending's name or institutional DEA suffix.

 

[pharmalt82]

I have had similar rejections from residents who are valid prescribers. There should always be someone available at the hospital you can contact. Even if it isn't the resident or the attending, somebody from that team should be available to get you a supervisor/attending's name or institutional DEA suffix.

I meant resident.
For example, a pediatrics resident (MD or DO) signing an Rx perfectly with the stamp indicating his NPI, DEA, State License, Hospital Doc Number, etc. for an Atarax Rx.
The insurance company rejects the Rx saying that the NPI is not covered/invalid.
Some insurances will do this.
You need the attending's name and NPI now. You must either call the hospital or have the ptn go back and get the attending's stamp. This is practically impossible to pull off. Is there any other legal solution?

 

[Travex]

How is it practically impossible? The hospital is open 24/7, if the attending is not available you can have a covering physician pull the charts and sign off on it instead. There is nothing you can do if you are unable to contact the hospital (although this seems unlikely).

 

[pharmalt82]

How is it practically impossible? The hospital is open 24/7, if the attending is not available you can have a covering physician pull the charts and sign off on it instead. There is nothing you can do if you are unable to contact the hospital (although this seems unlikely).

I've seen RPhs just guess on who the attending is like they don't even care. They don't do this for CSs though. From the RPhs POV, they are not getting paid to make the call to the doctor and the ptn is getting annoyed at them for doing so and it takes a million year phone call just to get through to the right personnel at a hospital, at least a big one.

 

[Ackj]

When you get the resident who wrote it on the phone, they are usually pissed about it. "What do you mean my NPI isn't valid? I can write this, I don't need my attending to write it!" Have to explain that it's just the patient's stupid insurance that has a problem with it.

I forget which plan, but there is one that allowed it to go through with a denial clarification of like 53 or 54 which meant institutional practitioner.

 

[owlegrad]

I forget which plan, but there is one that allowed it to go through with a denial clarification of like 53 or 54 which meant institutional practitioner.

I was just about to suggest that if the hospital is really that intolerable you could probably call the ins help desk to get an override. Can't imagine that being easier than just calling the hospital and asking who the attending is/was though.

 

[Carboxide]

If you call the insurance they will add the prescriber. We see this with one specific company all the time. It's no big deal.

 

[ohiopharmacist1]

If you get a rejection saying that prescriber DEA not associated (or valid,etc) on a Medicare D claim, verify that the DEA and NPI are correct, then use one of the following submission clarification codes in sub clar field #1:

42 - NPI is valid
43- DEA is being renewed
44 - DEA recently reactivated
45 - DEA is a valid hospital-issued number with suffix