National review of opioid prescribing for Medicaid beneficiaries not possible yet, OIG finds

All beneficiaries and providers at risk of opioid misuse can't be identified, rendering a national claims database of Medicaid opioid prescribing inadequate, according to a report from the Office of Inspector General.

Data in the national Medicaid claims database, called the Transformed Medicaid Statistical Information System, has several limitations, according to OIG. The limitations "impede identification of individual beneficiaries for national opioid analysis," according to the report. OIG said 32 states are missing data like national provider identifiers, diagnosis code or quantity.

"To ensure the identification of at-risk beneficiaries and providers who may be overprescribing, we recommend that CMS work to ensure that individual beneficiaries can be uniquely identified at a national level using T-MSIS, ensure the correct submission of prescriber NPIs, and clarify requirements for diagnosis codes."

CMS concurred with the recommendations.

Read the full report here.

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