Ballot Information

Public comments are solicited on proposed new standards and proposals to revise, reaffirm or withdraw approval of existing standards simultaneously with the NCPDP ballot period.

The NCPDP Ballot period opens on Wednesday, March 8, 2017 and closes Thursday, April 13, 2017. Should you wish to submit an Official Public Comment, the Council must receive your Official Public Comment no later than 5:00 p.m. PDT/ 6:00 p.m. MDT/ 7:00 p.m. CDT/ 8:00 p.m. EDT on Thursday, April 13, 2017. All explanatory comments submitted on "Object with Reason" and "Accept with Comments" will be reviewed at the next scheduled Joint Technical Work Group meeting, which will be held May 7-8, 2017 in Scottsdale, AZ.
  1. Ballot WG010074

    WG01 Telecommunication - Data Maintenance Packet, Ballot WG010074, for initial release of the Batch Standard Subrogation Implementation Guide

    This ballot contains the following changes from the listed DERFs:

    • DERF 1375 which requested the approval of the new NCPDP Subrogation Standard Implementation Guide and the addition of new fields, sunsetted fields and Telecommunication Implementation Guide modifications to be added to the next version of the Telecommunication Standard Implementation Guide to support the new Subrogation Standard Implementation Guide.
      Once the new Subrogation Implementation Guide is approved and at the same time the next version of the Telecommunication Standard is brought forward for HIPAA adoption, a DSMO request will be submitted to name the new Subrogation Standard be adopted for Medicaid Subrogation. Once the deadline for compliance with the new Subrogation Standard has passed, a DERF to sunset the Medicaid Subrogation Standard will be submitted. (Hence, it was determined there is no need to update the current Medicaid Subrogation Standard.)
      Note: Because DERF 1375 also impacts the Telecommunication ballot WG010075, failure of this ballot (WG010074) would require the requests on this DERF within ballot WG010075 to be removed.
    • DERF 1464 which requested to update BIN (101-A1) which is now called an Issuer Identification Number (IIN) by ANSI, increase the field length from 6 digits to 8 digits and update all BIN references to IIN.
      Note: See Telecommunication ballot WG010075 for details.
    • DERF 1481 which requested to change the field name, definition and situations for use of Field 433-DX Patient Paid Amount Submitted.
      Note: See Telecommunication ballot WG010075 for details.
    • Approval of ballot WG010074 would result in the initial release of the Batch Standard Subrogation Implementation Guide Version 10.

  2. Ballot WG010075

    WG01 Telecommunication - Data Maintenance Packet, Ballot WG010075, for enhancements to the Telecommunication Standard Implementation Guide, the Batch Standard Implementation Guide, the Post Adjudication Standard Implementation Guide, the Audit Transaction Standard Implementation Guide and the Uniform Healthcare Payer Data Standard Implementation Guide

    This ballot contains the following changes from the listed DERFs:

    • DERF 1375 which requested the approval of the new NCPDP Subrogation Standard Implementation Guide and the addition of new fields, sunsetted fields and Telecommunication Implementation Guide modifications to be added to the next version of the Telecommunication Standard Implementation Guide to support the new Subrogation Standard Implementation Guide.
      Once the new Subrogation Implementation Guide is approved and at the same time the next version of the Telecommunication Standard is brought forward for HIPAA adoption, a DSMO request will be submitted to name the new Subrogation Standard be adopted for Medicaid Subrogation. Once the deadline for compliance with the new Subrogation Standard has passed, a DERF to sunset the Medicaid Subrogation Standard will be submitted. (Hence, it was determined there is no need to update the current Medicaid Subrogation Standard.)
      Note: Because DERF 1375 also impacts the Subrogation Implementation Guide ballot WG010074, failure of that ballot (WG010074) would require the requests on this DERF within this ballot WG010075 to be removed.
    • DERF 1397 which requested the addition of a new field, Do Not Dispense Before Date, be added to the Telecommunication Standard to address the Do Not Fill Before date on Controlled Substance prescriptions and to align with correlating fields in the SCRIPT Standard.
    • DERF 1406 which requested the addition of a COB Claims Processing Guidelines Section to the Telecommunication Implementation Guide to support VD.0 Editorial Document FAQs transcribed to the implementation guide guidance (14 FAQs) and a distinct COB Section for existing VD.0 implementation guidance that is currently in various sections as well as new guidance as it relates to previously approved and balloted DERFs 1342-1353.
    • DERF 1407 which requested the addition of a new value to Payer/Health Plan ID Qualifier (568-J7) for Contract ID and a situational change within the Implementation Guide.
    • DERF 1410 which requested the addition of the Telecommunication Standard to the use of eight existing Formulary & Benefit fields, the addition of two new Telecommunication Response fields, the sunset of six Telecommunication Response fields and modifications to the Telecommunication Implementation Guide to support the identification of plan benefit parameters within Telecommunication Paid and Rejected transaction responses.
    • DERF 1411 which requested new Additional Message Information Qualifiers (132-UH) values to support the identification of plan benefit parameters within Telecommunication VD.0 paid and rejected responses until the distinct Response Claim Segment fields are available (See DERF 001410).
    • DERF 1412 which requested the addition of two new fields, Multiple Rx Order Group ID and Multiple RX Order Group Reason Code, to the Claim Segment of the Telecommunication Standard and guidance added to the specific segment discussion section of the Telecommunication Implementation Guide to provide clarification as to the reason multiple prescriptions for the same patient are being grouped together.
    • DERF 1414 which requested a change to the definition of Place of Service (307-C7) to align with the CMS definition and use. Changes were made to applicable situations and examples within the implementation guide to clarify the use of this field.
    • DERF 1436 which requested a new data type called email character set (ECS), change all appropriate email fields to this new format and add ECS to appropriate locations in the guide.
    • DERF 1437 which requested to incorporate FAQs from the Version D.0 Editorial Document into the body of the Batch Standard Implementation Guide.
    • DERF 1438 which requested to incorporate FAQs from the Version D.0 Editorial Document into the body of the Telecommunication Standard and to add a new Section 7.2.6 Syntax Error.
    • DERF 1439 which requested to add existing data element, Plan Name (600-96), to the Response Insurance Additional Segment and a new field, Other Payer Name (D23-M5), to the Response Other Payers Segment in order to accommodate the addition of Plan information that was added to the E1 transaction Response Other Benefit Detail Segment.
    • DERF 1440 which requested to rename the Response Other Benefit Detail Segment (Value 39, Segment Identification 111-AM) to Response Other Related Benefit Detail Segment in order to differentiate this segment from a potential new segment to support commercial insurance benefits. In addition, in order to have flexibility to support future benefit details, this DERF requested to add 15 new data elements to the renamed segment.
    • DERF 1441 which requested the sunset of Submission Clarification Code (420 DK) values of 9 (Encounter), 19 (Split Billing), 20 (340B), the addition of two new fields (Submission Type Code and Submission Type Count) and clarification within the implementation guide to ensure the Submission Clarification Code is used solely to override plan benefit limitations.
    • DERF 1443 which requested one new Other Payer Patient Responsibility Amount Qualifier (351-NP) value for “Amount Attributed To Unbalanced Patient Pay Response Received from Previous Payer”, one new Patient Pay Component Qualifier (C95-KQ) value for "Amount Attributed To Unbalanced Patient Pay OPPRA" and COB processing guidance to be published in the Implementation Guide.
    • DERF 1445 which requested changes to the Response Other Payers Segment to support the appropriate identification of other payer information within a transaction response.
    • DERF 1463 which requested to update the Batch Implementation Guide to support current business needs/requirements and its use by other sending/receiving entities.
    • DERF 1464 which requested to update BIN (101-A1) which is now called an Issuer Identification Number (IIN) by ANSI, increase the field length from 6 digits to 8 digits and update all BIN references to IIN.
    • DERF 1466 which requested to add a definition of a compound prescription claim to the Telecommunication Implementation Guide to clarify the appropriate use of the Compound Segment.
    • DERF 1468 which requested to add the comment Note: This is not the dispensing pharmacy, currently in the Data Dictionary for Facility Name (385-3Q), to the following equally applicable fields and to the Facility Segment within the Telecommunication Implementation Guide:
      • a) 388-5J Facility City Address (T)
        b) B37-1X Facility Country Code (T)
        c) 336-8C Facility ID (T,A,V)
        d) B95-3Z Facility ID Qualifier (T)
        e) 387-3V Facility State/Province Address (T)
        f) B20-7M Facility Street Address Line 1 (T) (Replaced 386-3U Facility Street Address)
        g) B21-7N Facility Street Address Line 2 (T)
        h) 672-W2 Facility Unit (V)
        i) 389-6D Facility Zip/Postal Code (T)
    • DERF 1470 which requested to expand the scope of the Multiple Rx Order Group concept approved in DERF 1412 to include Service Billing transactions by renaming the two fields to incorporate services as well as prescriptions and by adding a new value to the new reason code field.
    • DERF 1472 which requested to modify the explanation of Informational Only Designation to “The field is not designated as mandatory, required, or situational but communicates information that should be included when applicable.”
    • DERF 1473 which requested to create eight new Telecommunication response fields, rename current Telecommunication response fields and add new ECL qualifiers to support the identification of the reason for Formulary Alternatives and the identification of required treatment.
    • DERF 1475 which requested to add new response fields to the Response Claim Segment to support real-time, electronic communication of plan benefit restrictions that can be overridden based on professional judgement and the use of specific request fields and associated ECL values.
    • DERF 1476 which requested to add a new field, "Prescriber Place Of Service”, to the Prescriber Request Segment to leverage the CMS Place Of Service code set and to identify the place where professional services are rendered or patient encounter occurred that resulted in a prescription order. Also requested a new reject code “M/I Prescriber Place Of Service”.
    • DERF 1477 which requested changes to Request and Response fields associated to percent tax and flat tax (regulatory fee) fields to allow the Telecommunication Standard to better support current and future regulatory terms associated with these charges, differentiate how these charges are applied to prescription benefit versus non-prescription benefit claims, ensure alignment with COB claims processing methods, clarify tax/regulatory fee exempt conditions and define how percent tax rates are determined/applied.
    • DERF 1478 which requested to add a new field “Other Payer Benefit Classification" to the Response Other Payers Segment. This field and applicable values is needed to support the identification of the Other Payer's Benefit Classification e.g.: Prescription Benefit, Medical Benefit, Durable Medical Equipment Benefit, Behavioral Health Benefit, Dental, etc. known to be associated to the patient for eligibility transactions or applicable to the specific claim or service billing.
    • DERF 1479 which requested to add a new ECL value for Other Payer ID Qualifier (339-6C) when used in the Response Other Payers Segment to identify the payer name when no other distinct identifiers are available. In addition, it requested to increase the field length of Other Payer ID (340-7C) from 10 to 30 and a definition change from “ID assigned to the payer” to “Identification assigned to the payer”.
    • DERF 1480 which requested to reduce the maximum count for the COB Other Payments Count (337-4C) from 9 to 3 in the COB Request Segment and to reduce the maximum count for the Other Payer ID Count (355-NT) from 9 to 4 for billing and service claims only in the Other Payer Response Segment.
    • DERF 1481 which requested to change the field name, definition and situations for use of Field 433-DX Patient Paid Amount Submitted..

    Approval of ballot WG010075 would result in enhancements to the Telecommunication Standard Implementation Guide Version F2, the Batch Standard Implementation Guide Version 15, the Post Adjudication Standard Implementation Guide Version 47, the Audit Transaction Standard Implementation Guide Version 33 and the Uniform Healthcare Payer Data Standard Implementation Guide Version 23.

  3. Ballot WG010076

    WG01 Telecommunication - Data Maintenance Packet, Ballot WG010076, for enhancements to the Benefit Integration Standard Implementation Guide

    This ballot contains the following changes from the listed DERFs:

    • DERF 1443 which requested one new Other Payer Patient Responsibility Amount Qualifier (351-NP) value for “Amount Attributed To Unbalanced Patient Pay Response Received from Previous Payer”, one new Patient Pay Component Qualifier (C95-KQ) value for "Amount Attributed To Unbalanced Patient Pay OPPRA" and COB processing guidance to be published in the Implementation Guide.
    • DERF 1471 which requested the sunset of four fields used in the flat files for both the Dual Book and Single Book of Records and the sunset of four associated fields used in the XML file. These fields are being replaced with the new Components of Patient Pay elements.
    • DERF 1477 which requested changes to Request and Response fields associated to percent tax and flat tax (regulatory fee) fields to allow the Telecommunication Standard to better support current and future regulatory terms associated with these charges, differentiate how these charges are applied to prescription benefit versus non-prescription benefit claims, ensure alignment with COB claims processing methods, clarify tax/regulatory fee exempt conditions and define how percent tax rates are determined/applied.
    • DERF 1491 which requested to align the gender codes used in the F&B Standard with those used in SCRIPT.

    Approval of ballot WG010076 would result in enhancements to the Benefit Integration Standard Implementation Guide Version 12.

  4. Ballot WG020009

    WG02 Product Identification - Data Maintenance Packet, Ballot WG020009, for enhancements to the Product Identifiers Standard Implementation Guide

    This ballot contains the following changes from the listed DERF:

    • DERF 1486 which requested an update to Section 3.1 Formats of the Product Identifiers Standard Implementation Guide to be consistent with FAQ 7.5 How Do I Convert a GTIN12, GTIN14, or GLN (GTIN13) to a UPC to Create an NCPDP 11-digit UPC.

    Approval of ballot WG020009 would result in enhancements to the Product Identifiers Standard Implementation Guide Version 1.4.

  5. Ballot WG090009

    WG09 Government Programs - Data Maintenance Packet, Ballot WG090009, for enhancements to the Financial Information Reporting Standard Implementation Guide

    This ballot contains the following changes from the listed DERFs:

    • DERF 1464 which requested to update BIN (101-A1) which is now called an Issuer Identification Number (IIN) by ANSI, increase the field length from 6 digits to 8 digits and update all BIN references to IIN.

    Approval of ballot WG090009 would result in enhancements to the Financial Information Reporting Standard Implementation Guide Version 14.

  6. Ballot WG110072

    WG11 ePrescribing & Related Transactions - Data Maintenance Packet, Ballot WG110072, for enhancements to the SCRIPT Standard Implementation Guide, the Specialized Implementation Guide and the XML Standard

    This ballot contains the following changes from the listed DERFs:

    • DERF 1421 which requested to add four additional values to the ClinicalInfoTypesRequested to incorporate specific requirements for Medicare Part B for immunosuppressive drugs.
    • DERF 1432 which requested to add the value of “DI” (Device Identifier) to represent the Unique Device Identifier (UDI) for CodedReferenceQualifier, AllergyDrugProductCodedQualifier, ProductQualifierCode and CompoundIngredientProductCodeQualifier
    • DERF 1447 which requested a correction to the schema of field PrescriberCheckedREMSCode for NewRx, Renewal Response, and Rx Change Response to conditional with an annotation - only be required when the prescription is a REMS medication.
    • DERF 1448 which requested to enhance RxFill messaging to describe why orders/prescriptions were dispensed for quantities less than what was prescribed.
    • DERF 1449 which requested to correct the RxHistoryResponse element to mandatory so the receiver of the response knows if their request was accepted or denied.
    • DERF 1450 which requested to add a new segment to all MedicationPrescribed composites with a new element of PatientCodifiedNote.
    • DERF 1451 which requested to update the schema and implementation guide to allow the SIG directions on medication administration to be communicated and interpretable through just the free text for those not supporting the Structured & Codified version.
    • DERF 1452 which requested to add an annotation to the New Field, “Used for NADEAN (Narcotics Addiction DEA Number)” to clarify it contains the NADEAN (Narcotics Addiction DEA Number) required for Drug Abuse Treatment Identifier.
    • DERF 1453 which requested to add a new segment to MedicationPrescribed and MedicationDispensed in NewRx, Resupply, RxChangeResponse, RxFill, RxTransferResponse and RxRenewalResponse.
    • DERF 1454 which requested to sunset seven elements and replace with two new elements to consolidate dates for medication prescribed and medication dispensed. Note: ExpirationDate and EffectiveDate were sunset for use within the medication elements in applicable transactions but NOT within allergy, diagnosis, MTM service, PA response and CF inventory transactions where they are also used.
    • DERF 1455 which requested new reason codes to communicate any conflicts with prescriber authentication as it relates to prescription benefit coverage or state/federal regulatory requirements. These codes would be used when the prescription/order was dispensed or partially dispensed but where there was a prescriber authentication warning.
    • DERF 1456 which requested to sunset SelfAdministrationAllowed and add PlaceOfServiceNonSelfAdministeredProduct to leverage the CMS values for Place of Service and align with the Telecommunication Place of Service (307-C7) field definition and situation of use.
    • DERF 1487 which requested to simplify the current SCRIPT XML name space by using only one name space instead of six. This can be accomplished by changing the import statements in the XML schemas to include statements. XML messages would no longer need to declare a separate name space so the size and complexity would be smaller.
    • DERF 1488 which requested to correct the Renewal Response Denied Reason Code to optional. The SCRIPT Version 10.10 was inadvertently changed to mandatory although the SCRIPT Version 10.10 Implementation Guide shows it as optional on page 141. A note will be added on the Text/DenialReason stating “A DenialReason response must be accompanied by the Reasoncode or DenialReason explanation, or both.”
    • DERF 1489 which requested to add an optional Facility Segment to RxHistoryRequest and Response SCRIPT Transactions to allow the submission of a RxHistoryRequest from an acute care setting where it's a facility that is querying a repository for all recently filled or active medication for medical reconciliation purposes.
    • DERF 1490 which requested incorporation of the "RequestorRole" data element to the SCRIPT Standard for use in the Medication History Request, the addition of a new ReasonCode (ReasonCode6) to be used in Medication History Response for “RequestorRole not authorized to receive PDMP data” and guidance to be added to the Implementation Guidance under general Specific Element Discussion for RequestorRole.
    • DERF 1493 which requested the required field within the Sig elements to be modeled within the schema as an optional branch like the IntervalTiming elements for VariableAdministrationTimingModifier and AdministrationTimingNumericValue.
    • DERF 1494 which requested changes to the schema to:
      • a) Create a new branch for Dosage that includes a mandatory DoseUnitOfMeasure.
        b) Create a new branch for DoseCalculation that includes an optional DoseUnitOfMeasure.
        c) Make the dosage branch optional.
        d) Make the DoseCalculation branch optional.
        e) Make the DoseAmount branch optional.
        f) Remove DoseUnitOfMeasure from the main level of DoseAdministration.
        g) Modify the annotation for CalculatedDoseNumeric
    • DERF 1495 which requested a new data element, PrescriberPlaceOfService, be added to Prescriber to identify the place where professional services are rendered resulting in the prescription/order. The values submitted in this new element would leverage the CMS Place of Service code list submitted on professional claims.
    • DERF 1496 which requested to change the field name and definition of ProhibitRefillRequest.
    • DERF 1497 which requested modifications to allow the use of the RxChange messaging to communicate any conflicts with prescriber authorization as it relates to prescription benefit coverage or state/federal regulatory requirements.
    • DERF 1498 which requested a new optional structure called FollowUpPrescriber.
    • DERF 1499 which requested to add a new discrete data element called to all instances of , and for use by a prescriber to convey permissive authorization to a pharmacist to administer the product, vaccine, and/or device being prescribed/ordered.

    Approval of ballot WG110072 would result in enhancements to the SCRIPT Standard Implementation Guide Version 2017xx#, the Specialized Implementation Guide Version 2017xx# and the XML Standard Version 2017xx#.

  7. Ballot WG110073

    WG11 ePrescribing & Related Transactions - Data Maintenance Packet, Ballot WG110073, for enhancements to the Formulary and Benefit Standard Implementation Guide

    This ballot contains the following changes from the listed DERFs:

    • DERF 1410 which requested the addition of the Telecommunication Standard to the use of 8 existing Formulary & Benefit fields resulting in minor changes to the field definitions of Maximum Age (932-GA) and Maximum Amount (933-GB) and minor changes to value definitions of Maximum Amount Qualifier (934-GC) requiring inclusion of these changes for the Formulary and Benefit Standard.
    • DERF 1432 which requested to add the value of “DI” (Device Identifier) to represent the Unique Device Identifier (UDI).
    • DERF 1433 which requested to increase the field length of the Product/Service ID (407-D7) and other code set fields to 40 bytes to accommodate current identifiers and plan for future expansion. This DERF also provides modification to current NCPDP standards impacted by the requested field changes.
    • DERF 1457 which requested to remove verbiage within sections of the Formulary and Benefit guide which provide outdated directions for processing files.
    • DERF 1460 which requested to reduce the size of an alternatives list by applying the concept for all product identifiers in all F&B files whereby when a payer is using a Representative NDC, the payer is allowed to use an RxNorm TTY code to indicate what the Representative NDC represents. The single Representative NDC may represent a drug concept, a drug strength, a drug form, or drug strength and form. By using the RxNorm Qualifier in conjunction with a Representative NDC, files can be reduced in size.
    • DERF 1491 which requested to align the gender codes used in the F&B Standard with those used in SCRIPT.
    • DERF 1492 which requested a new field to indicate whether the copay range is a dollar amount or a percentage and the existing min/max copays description expanded to include %. This will apply to both the Summary and Detail Copay files.

    Approval of ballot WG110073 would result in enhancements to the Formulary and Benefit Standard Implementation Guide Version 51.

  8. Ballot WG110074

    WG11 ePrescribing & Related Transactions - Data Maintenance Packet, Ballot WG110074, for initial release of the Operating Rules for the Formulary and Benefit Standard

    This ballot contains the following changes from the listed DERFs:

    • DERF 1458 which requested approval of the NCPDP Operating Rules for the Formulary and Benefit Standard created to address the accuracy, timeliness, and presentation of the Formulary and Benefit Standard Versions 50 and later.

    Approval of ballot WG110074 would result in the initial release of the Operating Rules for the Formulary and Benefit Standard Version 10.

  9. Ballot WG110075

    WG11 ePrescribing & Related Transactions - Data Maintenance Packet, Ballot WG110075, for enhancements to the Prescription Transfer Standard Implementation Guide

    This ballot contains the following changes from the listed DERFs:

    • DERF 1407 which requested the addition of a new value to Payer/Health Plan ID Qualifier (568-J7) for Contract ID and a situational change within the Implementation Guide.
    • DERF 1436 which requested a new data type called email character set (ECS), change all appropriate email fields to this new format and add ECS to appropriate locations in the guide.
    • DERF 1464 which requested to update BIN (101-A1) which is now called an Issuer Identification Number (IIN) by ANSI, increase the field length from 6 digits to 8 digits and update all BIN references to IIN.
    • DERF 1468 which requested to add the comment Note: This is not the dispensing pharmacy, currently in the Data Dictionary for Facility Name (385-3Q), to the following equally applicable fields and to the Facility Segment within the Telecommunication Implementation Guide:
      • a) 388-5J Facility City Address (T)
        b) B37-1X Facility Country Code (T)
        c) 336-8C Facility ID (T,A,V)
        d) B95-3Z Facility ID Qualifier (T)
        e) 387-3V Facility State/Province Address (T)
        f) B20-7M Facility Street Address Line 1 (T) (Replaced 386-3U Facility Street Address)
        g) B21-7N Facility Street Address Line 2 (T)
        h) 672-W2 Facility Unit (V)
        i) 389-6D Facility Zip/Postal Code (T)
    • DERF 1479 which requested to add a new ECL value for Other Payer ID Qualifier (339-6C) when used in the Response Other Payers Segment to identify the payer name when no other distinct identifiers are available. In addition, it requested to increase the field length of Other Payer ID (340-7C) from 10 to 30 and a definition change from “ID assigned to the payer” to “Identification assigned to the payer”.
    • DERF 1480 which requested to reduce the maximum count for the COB Other Payments Count (337-4C) from 9 to 3 in the COB Request Segment and to reduce the maximum count for the Other Payer ID Count (355-NT) from 9 to 4 for billing and service claims only in the Other Payer Response Segment.

    Approval of ballot WG110075 would result in enhancements to the Prescription Transfer Standard Implementation Guide Version 36.

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