ProviderCheck

Power Points

Leave the guesswork behind. ProviderCheck gives an instant pass/fail status on the five critical data points of a prescriber’s status. Dispense and file claims with certainty.

FIVE POINTS TO PASS OR FAIL

Verisys designed ProviderCheck to give instant results to the pharmacy professionals who dispense prescriptions and those who file for reimbursement. The five points of truth help prevent dispensing and reimbursement for prescriptions from providers who don’t have the proper credentials to prescribe on a certain schedule, or to prescribe at all. The pass/fail dashboard empowers retail and health system pharmacies to act in accordance with standards and regulatory requirements.

A pass on each of these five points assures compliance while preventing fraud and protecting patients:

  • National Provider Identifier (NPI) status and type
  • Drug Enforcement Administration (DEA) registration and schedules
  • Fraud Abuse Control Information System (FACIS) for exclusion and sanctions
  • Medicare for enrollment status or opt-out
  • State License Boards for license status

NEED INSTANT VERIFICATION OF A PRESCRIBER’S CREDENTIALS? YES, IT’S REALLY THAT EASY.

The vital checkpoint

Verifying prescriber credentials with ProviderCheck is important to assure population safety. One quick check prevents fraud schemes against health systems, entitlement programs, private payers, and patients, while protecting your organization from exclusion, fines, and penalties.

The real-time transaction engine utilizes a provider’s name and NPI number to return a pass or fail for key data points that can be customized according to your business rules. Each inquiry report is connected to a specified date of service giving you rich data for use in audits and investigations. Using ProviderCheck on all transactions builds a powerful knowledge base for your organization.

IN CONTROL FROM FILLING TO BILLING

Knowing the status of prescribers with a real-time view of results puts you in control. Here’s how it works. Prescription inquiries can be sent individually during the transaction with instant results to protect your customers, as well as eliminate loss on non-reimbursable prescriptions. Your policies will guide whether the prescription is filled or not at the time of transaction based on the pass or fail status of the prescriber. This vital data can flag future transactions and inform the claims process.

ProviderCheck integrates with claims system and practice management software to ensure that only valid claims are sent to payers. Unleash the power of data.

10,000-FOOT VIEW

ProviderCheck is easily accessible by both ends of the shop. Verisys’ technology tells you if a provider’s credentials meet all standards for prescribing with a pass/fail dashboard view backed by all of the data results in an inquiry report.

To better understand the relevance of the standard data sets used by ProviderCheck, we outlined a quick summary of each one:

NPI

NPI is a standard that meets the Health Insurance Portability and Accountability Act (HIPAA) Administrative Simplification. It is a unique, 10-digit number that is required to fill prescriptions and file healthcare claims.

With ProviderCheck, you can verify that a provider’s credentials are in order, and that the provider’s NPI number being used for prescribing or referrals is active, and the correct type (personal or business). ProviderCheck can also return relevant parts of the NPI profile including the provider’s name, specialty (taxonomy), and practicing addresses.

DEA

The Drug Enforcement Administration (DEA) maintains a database of persons (including retired registrants) and organizations, certified and registered, who can handle controlled substances under the Controlled Substances Act.

A provider’s DEA number is registered with the DEA and affirms whether the provider is registered as a prescriber, distributor, or wholesaler of controlled substances. DEA numbers can be printed on prescription pads to indicate credentials to prescribe for controlled substances.

FACIS

Searching the FACIS database by Verisys for exclusions, debarments, and sanctions rules out whether the provider or entity is excluded from participating in government-funded programs. Exclusions apply to all administrators and management services furnished by the excluded provider regardless of who submits the claim. Entities submitting for reimbursement on claims for services ordered or prescribed by excluded providers or entities are subject to government fines, civil monetary penalties, and are ordered to pay restitution for the prescribed or referred products and services.

PECOS for Medicare / Medicaid enrollment

Provider Enrollment, Chain and Ownership System (PECOS) data shows whether the provider has any revocations pertaining to government-funded healthcare plans such as Medicare and Medicaid. This step will also show if a provider has chosen to opt-out of Medicare, Medicaid, or other entitlement programs.

State License

State medical licensing board data is used to verify provider licensure. ProviderCheck verifies the provider’s license status, taxonomy, requirements, and authorizations which vary state by state. For example, a Physician’s Assistant (PA) in Texas cannot issue a prescription without authorization from a registered physician, but in Utah, the PA does not need authorization.

With ProviderCheck, you can dispense and file claims with access to current, quality data that reduces your exposure to regulatory, legal, and financial risk through fraud.

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