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Invalid Prescriber Identifiers on Medicare Part D Drug Claims in 2016

Section 1860D-4(c) of the Social Security Act, as amended by Section 507 of the Medicare Access and CHIP Reauthorization Act of 2015 (MACRA), requires that, starting in plan year 2016, claims for a covered Part D drug must contain a valid prescriber National Provider Identifier (NPI). (P.L. 114-10 (April 6, 2015) § 507.) MACRA Section 507 requires the Secretary of Health and Human Services to establish procedures for determining the validity of the Part D prescriber NPIs. MACRA also requires OIG to submit to Congress a report on the effectiveness of these procedures no later than January 1, 2018. We will determine the extent to which invalid NPIs were used as prescriber identifiers on Part D prescription drug event records in 2016 and identify the procedures the Centers for Medicaid & Medicare Services has used to determine the validity of prescribers’ NPIs.

Announced or Revised Agency Title Component Report Number(s) Expected Issue Date (FY)
Jun-17 Centers for Medicare & Medicaid Services Invalid Prescriber Identifiers on Medicare Part D Drug Claims in 2016 Office of Evaluation and Inspections OEI-03-17-00040 2018

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