Sec. 8. Requiring valid prescriber National Provider Identifiers on pharmacy claims

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Section 1860D–4(c) of the Social Security Act ( 42 U.S.C. 1395w–104(c) ) is amended by adding at the end the following new paragraph: For plan year 2016 and subsequent plan years, the Secretary shall require a claim for a covered part D drug for a part D eligible individual enrolled in a prescription drug plan under this part or an MA–PD plan under part C to include a prescriber National Provider Identifier that is determined to be valid under the procedures established under subparagraph (B)(i).

The Secretary, in consultation with appropriate stakeholders, shall establish procedures for determining the validity of prescriber National Provider Identifiers under subparagraph (A). The Secretary shall establish procedures to ensure that, in the case that a claim for a covered part D drug of an individual described in subparagaph

(A)is denied because the claim does not meet the requirements of this paragraph, the individual is properly informed at the point of service of the reason for the denial. Not later than January 1, 2018, the Inspector General of the Department of Health and Human Services shall submit to Congress a report on the effectiveness of the procedures established under subparagraph (B)(i). .

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42 USC 1395w–104(c)

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Sec. 8

Requiring valid prescriber National Provider Identifiers on pharmacy claims

Cite42 USC 1395w–104(c)

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