Recoupment of MO HealthNet Funds from Improper DEA Number Usage

A key responsibility of the Missouri Pharmacy Association is to represent pharmacists and pharmacies on issues that impact your pharmacy/practice.  We were recently notified by Missouri’s MO HealthNet (MHD) Program that approximately 450 pharmacies in Missouri have shown up on a list of pharmacies with problems regarding some claims that were filed with MHD. I am writing to provide some guidance on how to proceed to avoid the impact of the recoupment of reimbursement dollars that have already been paid to you. If you are one of the listed pharmacies, you should have received notification from MHD. MPA is following up with a fax communication to this list as well.

The problem relates to the inappropriate use of pharmacy DEA numbers on some billing statements when used instead of the physician’s DEA or NPI number.  We have been working with staff at MHD to try to assist pharmacists in recovering these funds that will be automatically recouped through an upcoming payment.  There is only a short window of time to get the claims re-billed appropriately. If a claim is not corrected within two years of the original date of service MHD will not be able to reimburse you for the resubmittal of that claim.

If you have already received notification from MHD, we encourage you to respond immediately to their request by beginning to resubmit the claims shown in error.  They may be resubmitted now using the correct physician’s DEA or NPI number.  In the case of a hospital-based practitioner where their DEA/NPI number is unavailable, only the hospital DEA number will work.

Please let me know if you have any additional questions.  The Missouri Pharmacy Association stands ready to help in any way we can. For questions, please contact Drew Oestreich at the MPA office at (573) 636-7522.

Sincerely,

Ron L. Fitzwater, CAE

Chief Executive Officer

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