WG07 Manufacturer and Associated Trading Partner Transaction Standards - Data Maintenance Packet, Ballot WG070011, for enhancements to the Manufacturer Rebate Utilization, Plan, Formulary, Market Basket, and Reconciliation Flat File Standard Implementation Guide
This ballot contains the following changes from the listed DERFs:
- DERF 1389 which requested an update to the definition and associated values of Fill Number (403-D3) to reflect industry use. In order to appropriately apply the terms of subsequent fill and dispensing, additional changes to data elements and values are also requested.
- DERF 1446 which requested new fields to be added to the Manufacturer Rebate Standard to:
- Reintroduce diagnosis code information
- Provide additional fields for formulary and benefit file cross reference to eliminate use of the formulary field to reference these additional files.
- Provide utilization management indicators if formulary and benefit coverage files are not available or not a viable option
- Indicate 340B discount
- Provide more patient liability fields to provide detailed information on deductibles, tax, and copay/coinsurance
- DERF 1505 which requested to modify the descriptions of values P, A, and R values and add two new values, N and C, with associated descriptions for Reconciliation Status Code (602-11). Additionally, updates for these values are to be made within the implementation guide.
- DERF 1507 which requested to modify and add new values to Reconciliation Reason Code (602-10).
- DERF 1528 which requested updates to the descriptions of the ECL values for 308-C8 Other Coverage Code.
- DERF 1539 which requested clarification to version 07.02 (requested with DERF 1446) regarding the specific use of conditional data elements used to support a rebate invoice between trading partners as defined by contract terms.
- DERF 1540 which requested Field 600-73 Formulary Benefit Design Type in the Manufacturer Rebate Standard Formulary Description File be changed from “required” to “conditional” and its use based on trading partner agreement.
- DERF 1541 which requested modification to the definition of Reconciliation Error Description (Field 602-08) and revisions to the Manufacturer Rebate Standard to reflect this change.
Note: The DERF requests in this ballot are intended to align the Manufacturer Rebate Utilization, Plan, Formulary, Market Basket, and Reconciliation Flat File Standard Implementation Guide to Version D.0 of the Telecommunication Standard Implementation Guide. Future DERFs will be submitted to align the Manufacturer Rebate Utilization, Plan, Formulary, Market Basket, and Reconciliation Flat File Standard Implementation Guide to Version F2 (or the next HIPAA-named version) of the Telecommunication Standard Implementation Guide.
Approval of ballot WG070011 would result in the release of the Manufacturer Rebate Utilization, Plan, Formulary, Market Basket, and Reconciliation Flat File Standard Implementation Guide Version 07.02.