When processing a prescription claim that has been written for a federally scheduled controlled substance, pharmacies are tasked with validating that the DEA has granted the proper authority to the prescriber of that prescription. However, this process creates several challenges for pharmacies that can increase their risk for audits:

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  • National Prescription Identifier (NPI) numbers are used for prescription claim billing
  • An NPI number does not authorize the prescriber to write for controlled substances; the DEA grants that authority
  • The DEA authorizes prescribing authority for narcotics within the same schedule
  • When prescriber authority cannot be validated at the point of dispense, third parties pay the claim and flag it for review

Due to these challenges, the potential for pharmacy audits and financial losses has dramatically increased.

Validate prescriptive authority for pharmacy audit risk mitigation

RelayHealth's RelayRx™ Prescriber Authority Service helps retail pharmacies fulfill prescriptive authority validation requirements and helps mitigate against audit losses. In real-time, during claims adjudication, Prescriber Authority Service:

  • Determines the prescriber's DEA authority status
  • Determines drug(s) schedule and if drug is a narcotic
  • Validates level of prescriptive authority

Prescriber Authority Service is an unparalleled solution that lets your pharmacy efficiently comply with federal regulations and ultimately helps mitigate the impact of pharmacy audits or other financial penalties. RelayHealth offers a host of other audit risk and mitigation services including services to monitor for OIG excluded prescribers and other audit-triggering pharmacy claims transactions.

Features of Prescriber Authority Service:
  • Real-time validation of NPI-DEA numbers
  • Reporting provides narcotic indicators for each prescription
  • Response messaging provides transaction details that facilitate file updates
We can help:
  • Mitigate pharmacy audits and financial losses
  • Assist with compliance to federal rules and regulations
  • Provide data source for DEA-NPI matches
  • Reduce reliance on pharmacy personnel to validate prescriber authority