Action Required: Prescriptive Authority Claim Adjudication Changes Effective May 20, 2019

Date Issued: 5/20/2019

It’s important that our Medicare and Medicaid providers immediately review, validate and update if necessary the taxonomy code associated with your national provider identification (NPI) number as displayed in the National Plan and Provider Enumeration System (NPPES) database. If your taxonomy code is incorrect or not entered in the national database, effective May 20, 2019, your Medicare and Medicaid patients that have been prescribed controlled substances will not be able to refill them.

Express Scripts, our pharmacy benefit manager, has enhanced their prescription processing system to meet the requirements of the State Prescriptive Authority rules. The new logic will validate the prescriber has the appropriate authority to prescribe controlled substances based on state prescriptive authority rules. The logic will rely on the National Provider Identifier (NPI) number and the taxonomy code associated with the NPI as recorded in the NPPES database.

How do I review and/or update my taxonomy code?

  1. Look up your provider’s NPI in National Plan and Provider Enumeration System (NPPES) database by entering it here: npiregistry.cms.hhs.gov/
  2. Click on the NPI number to look at the full record, then scroll to the bottom to view the provider taxonomies. If the taxonomy is inaccurate, you can manage your providers’ NPIs here: nppes.cms.hhs.gov/#/
  3. Just log in to npiregistry.cms.hhs.gov/ using your username and password in the Individual NPI portion of the site and update the taxonomy code as needed. The taxonomy should update in real time.