The purpose of this bulletin is to address the misuse of Drug Enforcement Administration (DEA) registration numbers by insurers, HMOs, or other entities (health carriers) and to encourage use of the National Provider Identifier or other appropriate alternative identifiers.
A DEA registration number provides proof that the DEA has authorized an individual to buy, own, distribute, or prescribe controlled substances. Health carriers, however, often require a health care provider to submit its DEA registration number for identification purposes in processing claims. According to the DEA's Office of Diversion Control, such use is contrary to the intent of national drug control policies and could weaken the registration system. The DEA neither requires nor approves the use of DEA registration numbers by health carriers for noncontrolled substances claims.
A health carrier's requirement of a health care provider's DEA registration number for identification for reimbursement of a claim is inappropriate. Please make any necessary changes to your practices and procedures that involve inappropriate uses of DEA registration numbers.
Alternative identifiers are available for health carriers to use to identify health care providers. A health carrier could, for example, use a health care provider's state license number as a unique identifier. In addition, the National Provider Identifier (NPI) creates a unique identifier for health care providers. Health care providers governed by the Health Insurance Portability and Accountability Act (HIPAA) must obtain an NPI for purposes of identification in HIPAA transactions by the appropriate phase-in dates. Additionally, HIPAA-subject health care clearinghouses and both large and small health care plans must use the NPI for identification of health care providers by the appropriate phase-in dates. Pursuant to 45 Code of Federal Regulations § 162.404, a covered health care provider, health care clearinghouse, or large health care plan must use only the NPI for identification of health care providers on and after May 23, 2007.
A HIPAA-covered small health plan must comply with the NPI system on and after May 23, 2008. 45 C.F.R. §162.404 authorizes health carriers to use the NPI system to identify health care providers, whereas the use of DEA numbers by health carriers for identification purposes when controlled substances are not involved is prohibited. For identification purposes, health carriers should timely implement the NPI system or other appropriate alternative and should immediately discontinue any inappropriate use of the DEA number.
If you have any questions regarding this bulletin, please contact Ana Smith-Daley, Deputy Commissioner, Life/Health Division at 512-322-3401.
Commissioner of Insurance
March 17, 2006
To: ALL INSURERS WRITING ACCIDENT AND HEALTH INSURANCE AND HEALTH MAINTENANCE ORGANIZATIONS (HMOs) IN THE STATE OF TEXAS
Re: APPROPRIATE USE OF DEA REGISTRATION NUMBERS
For more information, contact: ChiefClerk@tdi.texas.gov