Very important question to pharmacists

[Medic_90x]

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Hello,

I'm a resident, and due to some technicalities with my SSN - my NPI was recently deactivated for a week-week and half ish. It was reactivated after I submitted paperwork yesterday.
Sent in a refill and the hospital pharmacy could not fill it as apparently they got a message saying I'm not a registered provider with Medicaid. I called Medicaid, and they were able to pull me up as active.

Anyone have experience with how NPI numbers work for any provider? New ones? Reactivation? It's the same number so shouldn't Medicaid/Medicare and all insurance companies be billable by any pharmacy now that I'm active? Is there a lag period between reactivation and appearing in all databases? No one has mentioned about needing to notify Medicaid/Medicare and plus not like new providers have to notify insurance companies etc.

Really appreciate any insight into this.
Thanks!!

 

[JustFillIt]

Insurance issues... it’s a nightmare..

I have seen this happen many times but it’s usually because an out of state provider is not registered with my state’s medicaid. I’m assuming this is not the case for you.

What I would do if I were you - I would track down the name of the patient, his/her insurance type, The ID number, and the help desk number associated with that patient’s insurance. The outpatient pharmacy should be able to get you all if that. Call the insurance yourself and identify yourself as the patients provider and get the very specific reason it was rejected and how it can be corrected. There may be one “medicaid” for your state, but then there may be multiple divisions within that outfit. For example, in my state, a patient may be active in the overall medicaid service, but there are different divisions such as “pregnant mothers insurance”. It may take a bit to trickle down to the others.

This is why you need to track the claim rejection to its source and get details. It’s probably a good idea to contact the patient and let them know you are doing this also.

 

[Medic_90x]

Insurance issues... it’s a nightmare..

I have seen this happen many times but it’s usually because an out of state provider is not registered with my state’s medicaid. I’m assuming this is not the case for you.

What I would do if I were you - I would track down the name of the patient, his/her insurance type, The ID number, and the help desk number associated with that patient’s insurance. The outpatient pharmacy should be able to get you all if that. Call the insurance yourself and identify yourself as the patients provider and get the very specific reason it was rejected and how it can be corrected. There may be one “medicaid” for your state, but then there may be multiple divisions within that outfit. For example, in my state, a patient may be active in the overall medicaid service, but there are different divisions such as “pregnant mothers insurance”. It may take a bit to trickle down to the others.

This is why you need to track the claim rejection to its source and get details. It’s probably a good idea to contact the patient and let them know you are doing this also.

Thanks for the reply. Everything is in-state! I was previously prescribing with no issues. Once deactivated, some Rx got rejected since it since "provider is not a Medicare recognized provider." I was reactivated and the pharmacy got a similar rejection comment but from Medicaid.

I got someone else to refill the Rx so the patient's fine.

But I guess what you're saying is that it may take a couple business days to reach everyone? This issue occurred over well under 1 business day after reactivation.

 

[owlegrad]

No one here can know for sure but likely the database just hadn’t updated yet.

Also this isn’t a “very important question to pharmacists” lol but hopefully this helps you.

 

[abrahamdrinkin]

I work at a health plan. So after we reactivate a provider, it takes 3-4 business days for all of the systems to have reloaded .

The process is gonna vary by claims processor.

 

[Medic_90x]

I work at a health plan. So after we reactivate a provider, it takes 3-4 business days for all of the systems to have reloaded .

The process is gonna vary by claims processor.

Thanks for the reply.
What do you mean by reactivate a provider? Just when the NPI is reactivated? Is there a manual step involved that each insurance company/Medicaid/medicare has to do? And if so, do they automatically do it as the NPI reactivates?

 

[JustFillIt]

Thanks for the reply.
What do you mean by reactivate a provider? Just when the NPI is reactivated? Is there a manual step involved that each insurance company/Medicaid/medicare has to do? And if so, do they automatically do it as the NPI reactivates?

Did you do what I recommended? Those are the people you should ask this question. Everything else is a guess.

 

[Medic_90x]

Did you do what I recommended? Those are the people you should ask this question. Everything else is a guess.

Won't be back till Monday so will do then if it's still an issue.

 

[abrahamdrinkin]

Thanks for the reply.
What do you mean by reactivate a provider? Just when the NPI is reactivated? Is there a manual step involved that each insurance company/Medicaid/medicare has to do? And if so, do they automatically do it as the NPI reactivates?

This is pretty much only a thing in Medicaid that I’m aware of. In Medicaid, by law, the state Medicaid program can only pay for RXs written by providers that are actively registered with the state Medicaid as providers.

So there’s an active Medicaid provider list kept in their provider database. This list gets exported. This may get bumped against an active NPI list before it gets loaded in the claims system to allow for claims payment. This probably gets done at a regularly recurring interval. It may or may not be manual.

 

[Medic_90x]

This is pretty much only a thing in Medicaid that I’m aware of. In Medicaid, by law, the state Medicaid program can only pay for RXs written by providers that are actively registered with the state Medicaid as providers.

So there’s an active Medicaid provider list kept in their provider database. This list gets exported. This may get bumped against an active NPI list before it gets loaded in the claims system to allow for claims payment. This probably gets done at a regularly recurring interval. It may or may not be manual.

I see thanks. So unlikely to affect other insurance companies and Medicare.

 

[JustFillIt]

I see thanks. So unlikely to affect other insurance companies and Medicare.

Yes - “Abraham Drinking” is correct

 

[Medic_90x]

Did you do what I recommended? Those are the people you should ask this question. Everything else is a guess.

This is pretty much only a thing in Medicaid that I’m aware of. In Medicaid, by law, the state Medicaid program can only pay for RXs written by providers that are actively registered with the state Medicaid as providers.

So there’s an active Medicaid provider list kept in their provider database. This list gets exported. This may get bumped against an active NPI list before it gets loaded in the claims system to allow for claims payment. This probably gets done at a regularly recurring interval. It may or may not be manual.

Still a lingering issue with Medicaid patients and random insurance companies. Called Medicaid, they said that I look fully active on their system with no issues. Called total care and Amerigroup who are the two companies covered by them, and they can't find me as a provider or even any history of me (even though I've sent scripts to patients covered by them before all of this).
Called a patient's insurance company, clueless responses.
Pretty much across the board - after speaking to 11 people, no one has a single clue. Only thing I've noticed is that I now show as "Active" on most NPI databases online now.
The pharmacist says they look into some database within the patient's insurance company or whatever. Did not explain further.

 

[abrahamdrinkin]

The pharmacist submits a claim and gets an immediate response as denied/rejected and a reason why.

They don’t check the system. I’m going to PM you.

 

[JustFillIt]

Still a lingering issue with Medicaid patients and random insurance companies. Called Medicaid, they said that I look fully active on their system with no issues. Called total care and Amerigroup who are the two companies covered by them, and they can't find me as a provider or even any history of me (even though I've sent scripts to patients covered by them before all of this).
Called a patient's insurance company, clueless responses.
Pretty much across the board - after speaking to 11 people, no one has a single clue. Only thing I've noticed is that I now show as "Active" on most NPI databases online now.
The pharmacist says they look into some database within the patient's insurance company or whatever. Did not explain further.

Welcome to insurance hell....

 

[JustFillIt]

The pharmacist submits a claim and gets an immediate response as denied/rejected and a reason why.

They don’t check the system. I’m going to PM you.

Well, the “reason why” is not always crystal clear...

 

[Medic_90x]

Hey this issue is still persisting... Couple insurance providers aren't having any issues but many still are. Everywhere I've called leads to a dead end conversation and the person on the line transfers me to someone else who is equally as confused.
Residents also aren't registered with each insurance provider the same way attendings are...

And impossible to get a new NPI.

Ugh..

 

[JustFillIt]

Hey this issue is still persisting... Couple insurance providers aren't having any issues but many still are. Everywhere I've called leads to a dead end conversation and the person on the line transfers me to someone else who is equally as confused.
Residents also aren't registered with each insurance provider the same way attendings are...

And impossible to get a new NPI.

Ugh..

You will find your way out of this hell. Just be careful not to wander aimlessly in the process.