NCPDP has released a new standard, the Subrogation Implementation Guide for Batch Standard Version 10 to be named in HIPAA to replace the Medicaid Subrogation Standard Implementation Guide, version 3.0, for Medicaid use only.

    A standardized subrogation process will allow payers and PBMs to more effectively handle common post-payment “pay and chase” scenarios without involving the pharmacy, such as:

    • Medicare Secondary Payer (MSP) - payments made by Medicare Part D plans as primary when a group health plan or other third party coverage should have paid as primary;
    • SPAP/ADAP – payments made when Medicare Part D should have paid the claims;
    • Plan/Benefit Changes – overpayments made by a payer due to retroactive coverage termination or a change in plan benefit design;
    • Payer/Processor Changes – payments made by the former processor when the new processor should have paid the claims; and
    • Other Party Liability – payments made by a health plan when another payer, such as Workers Compensation or Property & Casualty should have paid the claims.
    This implementation guide addresses the industry need to standardize the exchange of claim information between payers. This implementation guide does not address internal payer processes or communication of remittance information on recovered amounts.
    NCPDP has also released new versions of the Telecommunication Standard and Batch Standard to be named in HIPAA. The Telecommunication Standard Implementation Guide is version F2. The Batch Standard Implementation Guide is Version 15, which supports the Telecommunication Standard Version F2 in a batch mode. The Telecommunication Standard Implementation Guide supports the following processes:
    • Eligibility Verification
    • Claim
    • Service
    • Information Reporting
    • Prior Authorization
    • Predetermination of Benefits
    NCPDP has also released enhancements to several existing standards, including the Post Adjudication Standard, Audit Transaction Standard and Uniform Healthcare Payer Data Standard. The enhancements, as well as the new Subrogation Implementation Guide for Batch Standard, are available to members in the Member Portal.

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