The effective date for implementing the DEA Edits has been extended from May 13, 2013, to July 8, 2013.
Effective July 8, 2013, Alabama Medicaid will DENY any claim for a controlled drug written by a prescriber who does not have their Drug Enforcement Administration (DEA) number registered with the Department of Justice (DOJ) and on file at Medicaid. These edits are designed to prevent controlled substances from being filled when the prescription is written by an unauthorized prescriber. The following edits have been in place since November 2012 and are currently displaying as informational on the provider’s remittance advice:
Edit Description
1038 DEA NOT ON FILE FOR PRESCRIBER
1039 PRESCRIBER DEA NOT EFFECTIVE FOR DATE PRESCRIBED
1040 PRESCRIBER DEA DOES NOT PERMIT DRUG SCHEDULE
What action needs to be taken to prevent claims from denying on July 8, 2013?
Physicians – Make sure your DEA number is registered with DOJ and is on your enrollment file at Medicaid. Medicaid deadline for submission: June 21, 2013.
To confirm if your DEA number is appropriately registered with the DOJ, and to ensure your correct address/contact information is registered with the DOJ, you may go to the DEA website at:
https://www.deadiversion.usdoj.gov/webforms/validateLogin.jsp
Prescribers of controlled substances are mandated to re-register their DEA license every three years.
To ensure your DEA is on file at Medicaid, fax a copy of the provider’s DEA Registration Certificate to Provider Enrollment (fax 334-215-4298) and include the provider’s Name, NPI number, and license number on the certificate. Medicaid will apply the DEA to all service locations based on the provider’s NPI and license number. The DEA information should be received by Provider Enrollment prior to June 21, 2013. This deadline will allow Provider Enrollment time to enter the information in the provider’s file before the July 8, 2013, implementation date.
Pharmacies – If you are receiving the informational edits, contact the provider who ordered the prescription and advise them to fax a copy of the provider’s DEA Registration Certificate to Provider Enrollment (fax 334-215-4298) and include the provider’s Name, NPI number, and license number on the certificate.
Why is Medicaid implementing these changes?
In September 2009, the Government Accountability Office (GAO) issued the report “Medicaid Fraud and Abuse Related to Controlled Substances Identified in Selected States” which highlighted fraudulent, improper, or abusive actions in prescribing and dispensing of controlled substances. One of the report’s primary recommendations was that states should use the Drug Enforcement Administration (DEA) Controlled Substance Registration file as part of their Medicaid claims processing efforts to prevent paying for controlled substances ordered by unauthorized prescribers.
Prescribers: Please take a moment to validate your DEA number information. Medicaid encourages all providers to be proactive and ensure the DEA number of the prescribing provider is registered with the Department of Justice (DOJ) and on file at Medicaid prior to June 21, 2013.
NOTE: The claims which are currently paying and posting one of the informational edits above, will deny effective July 8, 2013.