Standards Information

NCPDP standards have transformed the pharmacy industry, saving billions of dollars in health system costs while increasing patient safety and quality of care. Many of our standards are named in federal legislation, including HIPAA, MMA, HITECH and Meaningful Use (MU).

As needs are identified, we update and enhance standards or create new ones. The current list of standards includes the following:

  • Audit Standard

    defines the record layout for batch audit transactions between Auditors and Providers to support electronic audit transactions that facilitate requests, responses, and final outcomes transmissions for both “Desk Top” claim audits and for in-store audit notices. This standard addresses the types of communication between Auditors and Providers and allows that communication to occur in an electronic environment rather than paper-based.

  • Batch Transaction

  • Benefit Integration

  • Billing Unit

  • Data Dictionary

  • External Code List

  • Functional Profiles for Electronic Health Record (EHR) Systems

  • Financial Information Reporting

  • Formulary and Benefit

  • Manufacturer Rebates

  • Medicaid Subrogation

  • Medical Rebates Data Submission

  • Operating Rules for Connectivity

  • Pharmacy and/or Combination ID Card

  • Post Adjudication

  • Prescription File Transfer

  • Product Identifiers

  • Prior Authorization Transfer

  • Retiree Drug Subsidy Standard Implementation Guide

  • SCRIPT

  • Specialized

  • Structured and Codified Sig Format

  • Telecommunication

  • Uniform Healthcare Payer Data Standard Implementation Guide

  • XML Standard Implementation

  • Universal Claim Forms

 

 
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