Why health systems maintaining accurate prescriber NPI lists helps them to power increased payer and patient access.
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Amanda Marrow
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Shelly Renkvish-Abo
Given these pressures, many health systems use Specialty Pharmacy Services Administrative Organizations (SPSAO) to reduce administrative burden and improve network access. SPSAOs help specialty pharmacies optimize patient care and outcomes by:
- connecting to PBM and payer networks
- drives increased capture rates with payers
- strengthening contracting and reimbursement
- streamlining operations, and
- supporting credentialing/accreditation, audits, and dispute resolution.
To maximize value, health systems and hospital specialty pharmacies should regularly provide Accelerate Pharmacy Solutions’ PSAO, Accelerate Specialty Network, with updated prescriber NPI lists.
What an NPI is – and why it matters
A National Provider Identifier (NPI) is a unique 10-digit HIPAA-required ID for U.S. healthcare providers, used for billing, electronic transactions, and identification across health plans. It’s permanent and publicly available in the National Plan and Provider Enumeration System registry.
There are two types:
- Type 1 (Individual): physicians and other clinicians
- Type 2 (Organization): hospitals, clinics, group practices
For specialty pharmacy network alignment, the “who’s writing” and “who’s billing” details matter – and accurate NPI rosters are foundational.
The benefits of keeping your NPI roster current
Accelerate Specialty Network can use your most up-to-date Provider NPI list to more effectively support your pharmacy and your health system in ways that directly impact growth and patient care, providing opportunities to provide a full scope of service for patients in-house. This in turn:
- Improves coordination between PSAOs and PBMs: Some PBM partners could coordinate with SPSAOs to provide advanced reporting to health systems to help increase capture rates. Without the right NPI mapping, opportunities can’t be reliably connected back to your providers.
- Strengthens reporting and analytics: Better NPI data improves targeting, attribution, and performance insights.
- Protects revenue and relationships: The hidden risk of outdated NPI lists is missed identification – patients seen by your providers may already be getting prescriptions filled elsewhere, and you may not even know it.
- Enhances patient access to medications: Accurate NPIs help ensure patients treated by your providers can be matched to the right pathways for in-house specialty pharmacy services.
- Facilitates contracting and network participation: Clean, current provider-NPI alignment helps reduce friction with PBMs and payers and supports enrollment, setup, and ongoing compliance more smoothly than those without clearly defined prescriber roster files.
The downside of not updating
By not keeping NPI numbers up to date, health systems risk missing real opportunities and losing patients without realizing it. For example, currently some Accelerate Specialty Network pharmacy benefit manager partner with Accelerate Specialty Network who is the innovator SPSAO to help find the best match pharmacy through different vendor partnerships and advanced reporting capabilities. If provider-to-NPI information isn’t accurate, those opportunities may not match correctly, and patients who could be eligible to a particular health system may end up elsewhere.
This is especially challenging for teaching hospitals, as providers rotate in and out frequently, which makes it hard to maintain a clean, current list. However, updating Accelerate Specialty Network once every few months can help minimize missed opportunities.
Best practices
Currently, most of the Accelerate Specialty Network’s network health system and hospital pharmacies are updating their NPI numbers on a regular basis.
A practical approach for health systems is to retrieve and maintain accurate provider NPI listings by leveraging internal credentialing/billing systems, external registries, and possibly 340B departments who must maintain these rosters for compliance with that program.
Establishing a consistent cadence to update records, perform periodic audits to validate provider-to-NPI alignment, and provide corrections or new NPIs promptly will help support compliance, clean claims processing, and smooth contracting and network participation.
Keeping provider NPI listings current isn’t busywork – it’s a high-leverage discipline that helps connect the right patients to the right care, through your specialty pharmacy, at the right time and with the right payer.
Source: NPPES FAQs https://nppes.cms.hhs.gov/help/faqs-help-page
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