February 8, 2008

Reminder – Arkansas Medicaid to

Require Submission with NPI Numbers

Arkansas Medicaid will soon be required by the Centers for Medicaid and Medicare Services (CMS) to require a valid NPI number for adjudication of pharmacy claims.  More specifically, pharmacies will be required to submit claims using their pharmacy’s NPI number and will be required to submit claims with a valid prescriber NPI number.

Recent data from Arkansas Medicaid suggests that as many as 85 percent of recent pharmacy claims were processed without a valid prescriber NPI number.  In addition, almost 25 percent of pharmacy claims were processed without a valid pharmacy NPI number.  Please note that these NPI numbers will be mandatory for proper claims submission to Arkansas Medicaid in the near future.

To locate NPI numbers for prescribers in your area, contact your pharmacy system vendor or visit the official NPI registry at http://nppes.cms.hhs.gov.

Aetna Audits

We have been notified that some pharmacies in Arkansas have been desk/phone audited by Aetna in the last few months.  The pharmacists involved feel these audits have been unfair and have not given the pharmacy adequate opportunity to prove that the claims in question were correct and legitimate.  This has resulted in recoupment before the pharmacy had been able to bring the issue to satisfactory resolution.  The association would like to hear from any pharmacy that has experienced these kinds of audits with similar unfair treatment.  If this problem is sufficiently wide spread, we may be able to get some relief through the attorney general's office or by some other legal means.  Please call or email the association if you have been affected.

Phone (501) 372-5250  ask for Mark or Scott

email   mriley@arpharmacists.org or scott@arpharmacists.org

Former APA Executive Richard Beck Recovering

APA is happy to report that former APA executive vice president Richard Beck underwent successful quadruple bypass surgery and is on the road to recovery.  In an e-mail to APA, Dr. Beck said he received many wonderful cards of support and encouragement, and that he was incredibly thankful to his colleagues in Arkansas for thinking of him during this time.