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Medicaid PA Provider Types and Pharmacy Providers- Issue Identified

Posted 22 days ago

ARAPA Members- 

We are aware of issues surrounding prescriptions being sent to pharmacies and pharmacies not recognizing PAs as a provider type which is resulting in prescription claims denials. Please see memo below from ARMedicaid which outlines anticipated resolution on 7/9/24. 

To:  Physician Assistant (PT 12/NV) and Pharmacy providers

Provider Type 12/specialty NV for physician assistant providers was implemented on July 1st.  The pharmacy vendor (Prime Therapeutics) was not made aware of this change in provider type.  Prescription claims from this provider type are being denied for Prescriber ID is not covered.  Prime Therapeutics will have the change in by 7/9/2024 and the claims will no longer deny incorrectly. 

There are two options to get these claims to pay prior to the implementation of the change:

  • Prescriptions can be written under the NPI of the physician that oversees the physician assistant. The pharmacy can contact the office of the physician assistant to make this change.
  • The pharmacy can contact Prime Therapeutics at 1-800-424-7895 during normal business hours (Monday – Friday 8:00 to 5:00 excluding state holidays) to override the denial.

Please contact Prime Therapeutics at 1-800-424-7895 during normal business hours (Monday – Friday 8:00 to 5:00 excluding state holidays) with any questions.