HIPAA and Claims Substantiation / No Name RX

[Guest sheilaparker]

We are receiving a number of Medical FSA claims with prescription receipts that do not reference the drug prescribed. Some pharmacists are telling us that because of HIPAA, they are not allowed to print the name of the drug on the receipt. Instead, they can provide a phone number and a prescription number and it is up to us to call them for the name of the drug.

Are any of you getting this kind of feedback?

Thanks....Sheila

[Steve72]

I assume you need the name of the drug to determine if it is a covered product under the FSA.

I'm assuming this is some kind of interpretation of the minimum necessary rule. I don't agree with the interpretation, but if they are willing to provide you with the information upon request, that may be the best option. Unfortunately, there are probably going to be issues raised like this for a while until an "industry standard" interpretation of many of HIPAA's rules is determined.

I would ask the pharmacists if they will print the name of the drug if specifically requested to do so by beneficiary. Then, notify beneficiaries that they should make such a request at the time services are provided to ease payment of their benefits.