November 27, 2017
Prescriber Exclusion – Excluded in One State, Excluded in All

Navitus Health Solutions regularly monitors certain
government agency lists that indicate prescribers who are excluded from providing services to a government program.
Navitus flags excluded prescribers so that those claims will reject from adjudicating.

As a pharmacy assisting patients with government program benefits, you may come across claims that are rejected for using excluded NPIs. We would like to make you aware of the following facts about prescriber exclusions:

  • Many Medicaid programs consider that a prescriber excluded in one state is excluded in all other states. Use caution when filling prescriptions for prescribers that may be excluded in other states.
  • While one Medicaid program may not list all other state exclusions on its own list, the laws of that state automatically include other state exclusions.
  • To resolve an exclusion, the prescriber must contact the source(s) responsible for his or her exclusion.
  • Navitus cannot process claims until the prescriber is cleared by the excluded entity.

Contact references:

Questions or concerns? You can reach the Navitus credentialing team at credentialing@navitus.com or 608-298-5776.

by Jessica Darling