News
NCPDP BALLOT DEADLINE IS JULY 28, 2008MINNESOTA UNIFORM COMPANION GUIDES
DEA PROPSED RULE FOR EPRESCRIBING OF CONTROLLED SUBSTANCES
WEDI CAQH AUDIOCAST
NCVHS RECOMMENDS EPRESCRIBING CHANGES FOR LONG TERM CARE
EPRESCRIBING MANDATED IN MINNESOTA
NEXT ROUND OF HIPAA TRANSACTIONS - ARE YOU READY?
NCPDP ISSUES RFP FOR UNIVERSAL CLAIM FORMS
MEDICARE PROGRAM; REVISIONS TO THE MEDICARE ADVANTAGE AND PRESCRIPTION DRUG BENEFITS PROGRAMS - PROPOSED RULE
DOING BUSINESS IN THE STATE OF MINNESOTA
NCPDP LAUNCHES DATAQ, A NEXT GEN PHARMACY DATABASE RESOURCE PROVIDING REAL-TIME ACCESS AND CUSTOMIZED REPORTING
AMA TELLS CMS: FINISH E-RX STANDARDS
UPDATED VERSION 5 EDITORIAL DOCUMENT PUBLISHED
NCPDP BYLAWS AND STANDING OPERATING PROCEDURES APPROVED
NPRM TO UPDATE HIPAA CODE SETS AND TRANSACTIONS
MAY DSMO BATCH
CMS RELEASES PART D E-PRESCRIBING FINAL RULE
NCPDP 2008 CO-CHAIR CANDIDATES ANNOUNCED
NEW UNIVERSAL CLAIM FORMS TO BE REVIEWED
LONG TERM CARE MEDICARE PART D REBATE REPORTING
CMS RELEASES PART D E-PRESCRIBING FINAL RULE
NCPDP PROVIDES MEDICAID AGENCIES WITH HCIDEA™ PRESCRIBER DATABASE - WAIVES LICENSE FEE
NCPDP PUBLISHES LONG-TERM CARE REBATE REPORTING GUIDANCE
NCVHS RECOMMENDS STANDARDS MOVE FORWARD UNDER HIPAA
OFFICE OF THE NATIONAL COORDINATOR USE CASE ANNOUNCEMENT
WHITE PAPER ON THE IMPACT OF THE NPI (NATIONAL PROVIDER IDENTIFIER) ON THE PHARMACY SERVICES SECTOR USING THE NCPDP STANDARDS
ONLINE JOB LISTINGS
NCPDP TELECOMMUNICATION VERSION 5 DOCUMENT AVAILABLE
NCPDP BALLOT DEADLINE IS JULY 28, 2008 Article |
The voting period for NCPDP ballots WG110034R, WG010032R, WG110035, and WG010033 ends MONDAY, JULY 28, 2008 at 5:00 p.m. PDT/ 6:00 p.m. MDT/ 7:00 p.m. CDT/ 8:00 p.m. EDT. PLEASE CAST YOUR VOTE.
These ballots are requesting enhancements to the SCRIPT Standard and Telecommunication Standard.
In order for a new ballot to be valid, it must receive votes from 60% of the Canvass Group. A person becomes a member of a Canvass Group by voting on one of the last two ballots. As a member of the Canvass Group, we ask that you review these ballots and cast your vote. If the ballot(s) have no direct impact on your business, you may wish to enter an "abstain" vote. Abstain votes are counted in the validation of a ballot.
Re-circulation ballots must obtain a 90% approval rating from votes cast. If you DID NOT vote on the original ballots, you may vote on the re-circulation ballots. If you DID vote on the original ballots and after reviewing the re-circulation documents, wish to change your original vote, please vote. To CHANGE YOUR ORIGINAL VOTE, YOU MUST VOTE on the Re-circulation Ballot. DO NOT VOTE on the Re-circulation Ballot UNLESS you wish to change your initial vote or did not vote on the original ballot.
Members: These ballots, along with the relevant documentation, are available in the Electronic Balloting area of NCPDP's website:http://www.ncpdp.org/members/members_login.asp?URL=/members/ballotstart.asp
Non-Members: Ballot documentation and voting instructions for non-members are available:http://www.ncpdp.org/Ballot_info_non-members.asp
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MINNESOTA UNIFORM COMPANION GUIDES Article |
In an effort to assist with outreach and communication, NCPDP has created a website page with information and links on the Minnesota Uniform Companion Guides activities underway. Please note that the statute the work is based on applies to all purchasers (payers) and providers doing business in the state of Minnesota, not just those participating in Minnesota Medicaid. Transactions affected include NCPDP Telecom 5.1 (claim, reversal), ASC X12 270/271, 835, and 837.
The AUC, and specifically, the Claims Data Definition Technical Advisory Group (TAG) is charged with the following: "To create and develop common standards in cases where Medicare does not meet Minnesota needs and Minnesota commercial health plan group purchasers require providers to submit the 837 professional, 837 institutional, 837 dental and NCPDP 5.1 pharmacy claims differently, depending upon the group purchaser. An overarching principle of this work is the fact that, each MN group purchaser and provider will be required to make changes to procedures, policies and/or systems in some way, as a result of the work of the AUC and the Claims Data Definition TAG." (emphasis added)
See http://www.ncpdp.org/members/members_government_state.asp.
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DEA PROPSED RULE FOR EPRESCRIBING OF CONTROLLED SUBSTANCES Article |
The Drug Enforcement Administration (DEA) has issued proposed rules for eprescribing of controlled substances. Public comments on the proposed rule will be accepted until September 25, 2008. The proposed rule is available at http://edocket.access.gpo.gov/2008/pdf/E8-14405.pdf NCPDP WG11 ePrescribing and Related Transactions will be responding to the rule from NCPDP's perspective. Member companies are encouraged to read the rule and submit comments from their company's perspective as there will be impact to business processes, products, services, and systems.
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WEDI CAQH AUDIOCAST Article |
In this 90-minute session, representatives from Siemens and Harvard Pilgrim HealthCare will provide a detailed review of the proposed CORE Phase II Connectivity Rule and its potential implications for the future of electronic healthcare information exchange. They will also share their perspectives and experience with participating in the CORE Rule development process and the drive toward implementation of the Rules. For more information and to register:
http://wedi.org/forms/meeting/MeetingFormPublic/view?id=7EC500000374
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NCVHS RECOMMENDS EPRESCRIBING CHANGES FOR LONG TERM CARE Article |
Based on testimony from the industry, the National Committee on Vital and Health Statistics submitted a recommendation letter to the Secretary of HHS requesting eprescribing updates, especially for long term care use.
Recommendation 1:
Once NCPDP SCRIPT Version 10.5 is balloted and approved, NCVHS recommends that it be considered for voluntary adoption under the streamlined process for backward compatible standards. This would provide the functionality needed in long-term care settings to communicate information about prescription drugs that have been dispensed to a patient among facility, physician, and pharmacy and would provide direction to vendors developing e-prescribing products for long-term care. It would also allow for the voluntary use of the most recent version of the SCRIPT standard in ambulatory settings.
Recommendation 2: NCVHS also recommends lifting the current exemption from the requirement to use the NCPDP SCRIPT standard for non-prescribing providers in long-term care settings. The exemption currently applies to prescribers when they are required by law to issue a prescription for a patient to a non-prescribing provider (such as a nursing facility) that in turn forwards it to a dispenser. While long-term care facilities would be able to voluntarily use the NCPDP SCRIPT 10.5 standard even while the exemption is in place, we believe lifting the exemption sends a clear message to the industry about the desirability of e-prescribing in long-term care.
The letter is available at http://www.ncvhs.hhs.gov/
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EPRESCRIBING MANDATED IN MINNESOTA Article |
Tim Pawlenty, Governor of Minnesota, recently signed legislation that mandates use of ePrescribing systems. As well, the new law further requires that all electronic health records systems implemented have CCHIT-certification.
The law requires that electronic prescribing be implemented by the beginning of 2011. Both medication dispensers and prescribers muse incorporate systems that utilize the National Council for Prescription Drug Programs' SCRIPT standard or Health Level Seven (HL7) messaging standards. These standards support transmission of prescriptions and related necessary information.
The new law, the 2008 Minnesota Health Care Reform Act or Senate File 3780, includes other provisions intended to increase both the availability and coverage of health insurance, reform the processes for payment, and increase the transparency of quality and pricing data. Additional components include improvements for the management of chronic care and funding programs to combat obesity and use of tobacco products.
Use of electronic health records are not mandated in the legislation passed. The requirement for CCHIT certification will ensure that various systems implemented across the state will be interoperable. Those systems must also be able to support ePrescribing.
Click Here for more information.
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NEXT ROUND OF HIPAA TRANSACTIONS - ARE YOU READY? Article |
The NCPDP Strategic National Implementation Process (SNIP) has created an important white paper to assist the industry in preparing for the next round of HIPAA-named transactions. It's time to get started! For information, go to http://www.ncpdp.org/news_hipaa_snip.asp.
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NCPDP ISSUES RFP FOR UNIVERSAL CLAIM FORMS Article |
NCPDP has now issued a Request for Proposal (RFP) for the marketing, manufacture, and distribution of the current and new Universal Claim Forms (UCFs). To request a copy of the RFP please contact Lynne Gilbertson at lgilbertson@ncpdp.org with subject heading "UCF RFP". Instructions found in the RFP must be followed.
Universal Claim Forms are forms used for processing pharmacy prescription claims. The industry uses standard electronic formats for billing billions of claims per year. Paper UCFs are used for claims that are too old to be submitted electronically, or require special processing, or for pharmacies that do not submit electronic claims (which is not the norm). The UCFs are designed for use by the pharmacy, not the patient. NCPDP is seeking a partner for the marketing, manufacture, and distribution of the paper UCFs, and electronic solutions.
Of Note to Responders:
NCPDP's WG1 Telecommunication and WG16 Property and Casualty/Workers' Compensation joint Task Group created the prototypes and reference implementation guide for two universal claim forms. The ballot period of the two UCFs is June 20 - July 28, 2008. Ballot comments will be discussed during the August Work Group meetings, during WG1 Telecommunication sessions.
The Universal Claim Form has been updated to align with the Telecommunication Standard Version D.0. The new Workers' Compensation/Property and Casualty Universal Claim Form also aligns with Telecom D.0, and includes needs specifically for these types of pharmacy claims. Also included is a Reference Guide to provide more information on filling out and processing a claim form.
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MEDICARE PROGRAM; REVISIONS TO THE MEDICARE ADVANTAGE AND PRESCRIPTION DRUG BENEFITS PROGRAMS - PROPOSED RULE Article |
The Department of Health and Human Services, Centers for Medicare & Medicaid Services have published a proposed rule (42 CFR Parts 422 and 423 CMS 4131-P RIN 0938-AP24) in the Federal Register on Friday, May 16, 2008. which may be of interest to member companies.
From the Summary: This proposed rule would make revisions to the Medicare Advantage (MA) program (Part C) and prescription drug benefit program (Part D). The regulation contains new regulatory provisions regarding special needs plans, medical savings accounts (MSA) plans, and cost-sharing for dual eligible enrollees in the MA program, the prescription drug payment and novation processes in the Part D program, and the enrollment, appeals, and marketing processes for both programs. We are proposing these changes based on lessons learned since 2006, the initial year of the prescription drug program and the revised MA program. DATES: To be assured consideration, comments must be received at one of the addresses, no later than 5 p.m. on July 15, 2008.
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DOING BUSINESS IN THE STATE OF MINNESOTA Article |
Please note that the following applies to all purchasers (payers) and providers doing business in the state of Minnesota, not just those participating in Minnesota Medicaid.
Minnesota Statutes, section 62J.536, requires the Minnesota Commissioner of Health, in consultation with the Minnesota Administrative Uniformity Committee (AUC), to promulgate rules requiring group purchasers and healthcare providers to exchange healthcare administrative transactions electronically, using a single, uniform companion guide to the implementation guides described under Code of Federal Regulations, title 45, part 162.The AUC, and specifically, the Claims Data Definition Technical Advisory Group (TAG) is charged with the following: "To create and develop common standards in cases where Medicare does not meet Minnesota needs and Minnesota commercial health plan group purchasers require providers to submit the 837 professional, 837 institutional, 837 dental and NCPDP 5.1 pharmacy claims differently, depending upon the group purchaser. An overarching principle of this work is the fact that, each MN group purchaser and provider will be required to make changes to procedures, policies and/or systems in some way, as a result of the work of the AUC and the Claims Data Definition TAG." (emphasis added)
While the official comment period has closed, we would encourage you to closely review these documents and contact the appropriate resources with any concerns you have, or to become active in the AUC process. More information can be found at http://www.health.state.mn.us/asa/rules.html.
Definitions for group purchasers and healthcare providers are available at https://www.revisor.leg.state.mn.us/statutes/?id=62J.03 NCPDP has been told that a list of impacted entities will be published soon.
The current versions of these companion guides can be found at http://www.health.state.mn.us/auc/index.html
.
The Department of Health is to send this to the state on 05/27/2008. It will be published in the state register on 06/09/2008. It takes effect 07/09/2008 and compliance date is 07/15/2009. NCPDP has submitted a letter strongly requesting these documents do not proceed forward until pharmacy industry representatives and NCPDP review these documents for impact to the industry, and changes made to incorrect information.
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NCPDP LAUNCHES DATAQ, A NEXT GEN PHARMACY DATABASE RESOURCE PROVIDING REAL-TIME ACCESS AND CUSTOMIZED REPORTING Article |
SCOTTSDALE, Ariz. - April 23, 2008 - The National Council for Prescription Drug Programs (NCPDP), today announced the launch of dataQ™, a next generation pharmacy data solution that provides healthcare stakeholders with the most up-to-date and in-depth pharmacy information available. dataQ enables pharmacies, PBMs, health plans and other stakeholders improved pharmacy database accuracy and streamlined electronic claims processing for faster reimbursement of prescription drug claims. It is also used for pharmacy network development and credentialing, data validation, drug utilization monitoring and product recalls, along with market research and analysis.
Available with varying subscription and administrative levels, the new resource expands functionality to include optional real-time web access to pharmacy data, extensive custom reporting and file download capabilities. dataQ's industry-leading accuracy and integrity is based NCPDP's on deep data validation, verification and documentation processes, which have been trusted for decades. The launch reflects a natural evolution of the Standard Pharmacy Database v2.1 product containing almost 75,000 pharmacies, which will continue to be available. Originally developed to provide NCPDP Provider ID enumeration, the unique identifier for pharmacies, it now contains the new National Provider Identifier (NPI) on pharmacies and has grown to be the industry's most comprehensive database of consistently updated pharmacy information.
"Using a time-tested method of assigning "intelligent" identification codes to data fields, dataQ provides more than just raw data; it is a way to identify, sort and categorize that data in a nimble manner previously unavailable in the industry," stated NCPDP President LeeAnn Stember. "It is an invaluable data tool for payers and other drug claims processors, pharmacies, pharmaceutical and biotech manufacturers, informatics companies, pharmacy practice management system vendors, list procurement vendors and more. The new solution will allow pharmacies to have more access and control over their own information, with the ability to update their data via any web-based browser and view their data in a real-time environment."
Added Stember, "With the new real-time look-up option for subscribers, we anticipate that dataQ will become an indispensable troubleshooting tool that empowers healthcare organizations to enhance productivity, reduce costs and improve the bottom line."
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AMA TELLS CMS: FINISH E-RX STANDARDS Article |
The American Medical Association is calling on Congress to require the Department of Health and Human Services to complete all national technical standards to support electronic prescribing by the end of 2009.
Further, if e-prescribing is mandated under Medicare or more broadly, the Chicago-based organization supports a two-year transition period after the standards are complete, during which physicians and pharmacies can use facsimiles to transmit prescriptions.
The AMA's proposals were outlined May 9 during a forum on ePrescribing at the Brookings Institution in Washington.
"Special attention also will be necessary for low-volume prescribers, small physician practices, and rural settings where financial, technical and operational challenges may require special exemptions or accommodations," said Steven Stack, M.D., an AMA Trustee and chair of emergency medicine at St. Joseph Hospital East in Lexington, Ky.
In April, the Centers for Medicare and Medicaid Services issued a final rule adopting three standards to support formulary and benefits, medication history and fill status notification components of ePrescribing.
Now, the AMA wants quick action on three additional standards. "Prescribers should be able to efficiently transmit accurate and complete instructions for medications being prescribed, use standard medication terminology, and use real-time prior authorization," Stack said. "So, it really is essential that these three incomplete standards be finalized and fully functional in order to realize the truly robust e-prescribing benefits sought by so many."
The AMA also called for elimination of federal Drug Enforcement Administration prohibitions on ePrescribing of controlled substances. The association estimates these substances account for 20% of all prescriptions.
http://www.ama-assn.org/ama/pub/category/18552.html
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UPDATED VERSION 5 EDITORIAL DOCUMENT PUBLISHED Article |
The "Telecommunication Version 5 Questions, Answers, and Editorial Updates" is available on the NCPDP website on the HIPAA public or members only WG1 Telecommunication page. The document has been updated with information from CMS on the use of the Prescription Origin Code (419-DJ) in the future, which was discussed during WG1 Telecommunication in May. See the appendix of changes for the specific section (click here).
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NCPDP BYLAWS AND STANDING OPERATING PROCEDURES APPROVED Article |
During the General Business Session of NCPDP's Annual Conference May 4-8, 2008, the updated NCPDP Bylaws and Standing Operating Procedures were approved by the membership. These documents have now been posted on the NCPDP website. Go to the dropdown menu in the About Us section.
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NPRM TO UPDATE HIPAA CODE SETS AND TRANSACTIONS Article |
In the May 5, 2008 Federal Register, the Department of Health and Human Services listed the Notice of Proposed Rule Making (NPRM) to Update HIPAA Code Sets and Transactions with a Release Date of 06/2008. Entities should begin their business planning and timelines to support the next transactions and code sets, and to be able to respond to the NPRM request for comments. The NCPDP Strategic National Implementation Process (SNIP) has created an important white paper to assist the industry in preparing.
http://www.ncpdp.org/news_hipaa_snip.asp
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MAY DSMO BATCH Article |
The May 2008 batch of Change Requests from the Designated Standards Maintenance Organizations (DSMO) website is available for member viewing on the MC Maintenance and Control page (click here) under the section "DSMO CRS Change Requests". NCPDP has collaborated on one Change Request.
- CRS 1069 requests to recommend to NCVHS that CPT guidelines be specifically named as part of the national standard for implementing CPT codes, which would require their use in HIPAA standard transactions. This change can be put forward in the upcoming ICD-10 Notice of Proposed Rulemaking.
This Change Request has been assigned to WG10 Professional Pharmacy Services. Recommendations of the work group will be discussed and voted for approval in MC Maintenance and Control.
Thank you.
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CMS RELEASES PART D E-PRESCRIBING FINAL RULE Article |
CMS released the Part D electronic prescribing final rule today, establishing Part D e prescribing standards for four types of information. The standards adopted under the rule will apply to all Part D sponsors, as well as to prescribers and dispensers that electronically transmit prescriptions and prescription-related information about Part D covered drugs prescribed for Part D eligible individuals. The rule adopts four standards for use in e-prescribing:
- Formulary and benefits: Allows prescribers to communicate with Part D sponsors about which drugs are covered by the patient's prescription drug benefit plan. Prescribers can also learn which generic prescription drugs might offer lower-cost options for the individual.
- Medication history: Allows providers, dispensers and Part D sponsors to communicate among themselves about prescribed medications a beneficiary has taken or is taking, including those prescribed by other providers. This information can help reduce the number of adverse drug events and can help ensure that the prescriber has the necessary information about a beneficiary's current prescription medications.
- Fill status notification: Allows providers to receive a transaction from dispensers telling them that a patient's prescription has been picked up, not picked up, or has been partially filled. These notifications can help health care providers monitor patients with chronic conditions by providing an indicator as to whether they are taking their medicines.
- Provider identifier: Requires providers, dispensers, and Part D sponsors to use the National Provider Identifier (NPI) to identify individual health care providers in Part D e prescribing transactions. Adoption of the NPI will speed workflows by eliminating call-backs by pharmacies to medical offices to verify the identity of individual prescribers.
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NCPDP 2008 CO-CHAIR CANDIDATES ANNOUNCED Article |
The 2008 Co-Chair Ballot will be available at Work Group registration May 4-5, 2008. You must be present to vote. The ballot will close at 10:30 am Monday, May 5, 2008. We would appreciate your voting on Sunday so we can tally up most of the ballots on Sunday. The Co-Chairs will be announced on Monday, May 5, 2008 during MC Maintenance and Control. NCPDP wishes to sincerely thank the candidates and their companies for their support or and participation in NCPDP leadership.
Click Here to view the Co-chair nominees document.
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NEW UNIVERSAL CLAIM FORMS TO BE REVIEWED Article |
NCPDP's WG1 Telecommunication and WG16 Property and Casualty/Workers' Compensation joint Task Group has been working on the prototype and reference implementation guide for two universal claim forms (UCFs). The documents have been brought forward as a Data Element Request Form (DERF) 846 and will be discussed during the NCPDP May Work Group meetings, during WG1 Telecommunication sessions. The Universal Claim Form has been updated to align with the Telecommunication Standard Version D.0. The new Workers' Compensation/Property and Casualty Universal Claim Form also aligns with Telecom D.0, and includes needs specifically for these types of pharmacy claims. Also included in the DERF is a Reference Guide to provide more information on filling out and processing a claim form. NCPDP will be posting a RFP in the future for the manufacture and distribution of the Universal Claim Forms. An announcement will be going out in the future; please do not inquire at this time.
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LONG TERM CARE MEDICARE PART D REBATE REPORTING Article |
Fourth Quarter 2007 LTC Rebate Reports must be submitted by April 30, 2008.
CVS Caremark, Argus, Express, FLRx, Medco, MedImpact, Prime Therapeutics, Rx America and WellPoint PBMs utilize www.premierltcsubmit.com for all Medicare Part D Long Term Care rebate reporting. If your pharmacy does not have any rebates to report, please utilize the Web site to identify "No Rebates." If you have any questions regarding the Smith Premier Web site, you may utilize the help function on their Web site or contact them at, 1-800-247-4526.
If the pharmacy processes claims for a PBM that is not listed above please contact that entity to obtain information on their rebate reporting process.
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CMS RELEASES PART D E-PRESCRIBING FINAL RULE Article |
CMS released the Part D electronic prescribing final rule today, establishing Part D e prescribing standards for four types of information. The standards adopted under the rule will apply to all Part D sponsors, as well as to prescribers and dispensers that electronically transmit prescriptions and prescription-related information about Part D covered drugs prescribed for Part D eligible individuals. The rule adopts four standards for use in e-prescribing:
- Formulary and benefits: Allows prescribers to communicate with Part D sponsors about which drugs are covered by the patient's prescription drug benefit plan. Prescribers can also learn which generic prescription drugs might offer lower-cost options for the individual.
- Medication history: Allows providers, dispensers and Part D sponsors to communicate among themselves about prescribed medications a beneficiary has taken or is taking, including those prescribed by other providers. This information can help reduce the number of adverse drug events and can help ensure that the prescriber has the necessary information about a beneficiary's current prescription medications.
- Fill status notification: Allows providers to receive an electronic notice from dispensers telling them that a patient's prescription has been picked up, not picked up, or has been partially filled. These notifications can help health care providers monitor patients with chronic conditions by providing an indicator as to whether they are taking their medicines.
- Provider identifier: Requires providers, dispensers, and Part D sponsors to use the National Provider Identifier (NPI) to identify individual health care providers in Part D e prescribing transactions. Adoption of the NPI will speed workflows by eliminating call-backs by pharmacies to medical offices to verify the identity of individual prescribers.
The new e-prescribing requirements will be effective on April 1, 2009. This final rule on Part D e prescribing standards (CMS-0016-F/CMS-0018-F) and the earlier final rule establishing e prescribing foundation standards (CMS-0011-F) will be available online at http://www.cms.hhs.gov/EPrescribing/
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NCPDP PROVIDES MEDICAID AGENCIES WITH HCIDEA™ PRESCRIBER DATABASE - WAIVES LICENSE FEE Article |
Scottsdale, AZ - After careful consideration and in an effort to streamline the transition from legacy prescriber identifiers to the NPI on the HIPAA named NCPDP Telecommunication Standard for pharmacy claims, the National Council for Prescription Drug Programs (NCPDP) has announced that it is waiving the annual license fee on its HCIdea™ Prescriber Database product for all Medicaid agencies.
The HCIdea™ product is a relational database containing prescriber DEA numbers, state licenses, NPIs, multiple addresses and other prescriber information. It obtains prescriber NPIs from the CMS National Plan and Provider Enumeration System (NPPES) only, the supplier of prescriber NPIs and primary data source. Providing NPPES data in a format useful for those processing Medicaid prescription drug claims solves a nagging problem for the prescription drug benefit industry which in many cases has been unable to obtain the correct NPI for prescribers.
The database will be provided free of charge for one year, with monthly updates. The offer is available immediately upon the signing of a subscription license. In return, Medicaid agencies agree to provide NCPDP through its technical partner, Ingenix, Inc. with a simple file of prescriber Medicaid IDs so that NCPDP may complete the NPI to Medicaid ID crosswalk needed for some agencies.
A not-for-profit ANSI-accredited standards development organization, NCPDP's mission is to provide standards to the pharmacy services sector. Part of that mission is to provide a "source of truth" for prescriber NPIs to ease the transition for pharmacies and other stakeholders involved in the prescription drug benefit.
The HCIdea™ database was built specifically to solve the prescriber identifier problem that exists for the pharmacy services sector. Pharmacies and PBMs do not usually have business relationships with prescribers and utilizing the NPPES downloadable database effectively, requires significant technical expertise. NCPDP engaged Ingenix, Inc. in 2006 to aid in this effort.
Using HCIdea™ insures that Medicaid agencies:
- Have a proven DEA to NPI crosswalk and soon a Medicaid ID to NPI crosswalk for prescribers.
- Have only Type 1 NPIs identifying prescribers and do not mistakenly use Type 2 group practice NPIs for the prescriber - decreasing the number of rejected claims and possible service disruption.
- Can transition pharmacy claims from legacy identifiers to NPIs sooner and in a more orderly manner through the CMS Contingency Period.
- Can shorten the legacy-to-NPI transition period, minimizing the period in which Medicaid surveillance and utilization review activities are disrupted.
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NCPDP PUBLISHES LONG-TERM CARE REBATE REPORTING GUIDANCE Article |
NCPDP has announced publication of an update to the guidance for reporting of rebates entitled Long-Term Care (LTC) Rebate Reporting Guide for Medicare Part D, developed by the WG14 Long Term Care Pharmacy Rebate Task Group in collaboration with Centers for Medicare and Medicaid Services (CMS). This document provides guidance for LTC pharmacies in reporting rebates to Part D sponsors or Pharmacy Benefit Managers representing Part D sponsors, and identifies inherent limitations in both the scope and the use of the data. The document was modified at the request of CMS to address a technical error in the original LTC Rebate file layout. The modification changed the field definition from numeric to text for information, such as NPI, in which leading zeroes must be maintained. This document is available on the NCPDP website at
http://www.ncpdp.org/news_feds.asp#rebate.
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NCVHS RECOMMENDS STANDARDS MOVE FORWARD UNDER HIPAA Article |
On September 26, 2007, the National Committee on Vital and Health Statistics recommended to the Department of Health and Human Services that the following transactions be moved through the Notice of Proposed Rule Making (NPRM) processes.
- NCPDP Telecommunication Standard Implementation Guide Version D.0 (replace Version 5.1)
- NCPDP Batch Standard Implementation Guide Version 1.2 (replace Version 1.1)
- NCPDP Medicaid Subrogation Standard Implementation Guide Version 3.0 (new transaction)
- ASC X 12 834, health plan enrollment;
- ASC X12 820, premium payments;
- ASC X12 270/271, eligibility inquiry and response;
- ASC X12 278, health care services - request authorization;
- ASC X12 837, health care claims/encounters (institutional, professional and dental);
- ASC X12 276/277, health care claim status request and response; and
- ASC X12 835, health care claim payment/remittance advice.
and the version 5010 replacement of the version 4010A1 X12 implementation guides:
Please see www.ncvhs.hhs.gov for the full recommendation letter.
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OFFICE OF THE NATIONAL COORDINATOR USE CASE ANNOUNCEMENT Article |
In January 2007, the American Health Information Community (AHIC) approved a recommendation to develop use cases that address certain aspects of public health case reporting, consultation and transfers of care, personalized healthcare, immunizations and response management, remote monitoring, and remote consultation. AHIC is a federally-chartered advisory committee and provides input and recommendations to the Department of Health and Human Services (HHS) on how to make health records digital and interoperable, and assure that the privacy and security of those records are protected, in a smooth, market-led way.
The 2008 Use Cases are being developed by the Office of the National Coordinator for Health Information Technology (ONC) with opportunities for review and feedback by interested stakeholders within both the private and public sectors. To facilitate this process, the use cases are being developed in two stages:
- The Prototype Use Cases describe the candidate workflows for the use case at a high level, and facilitate initial discussion with stakeholders; and
- The Detailed Use Cases document all of the events and actions within the use case at a detailed level.
The prototype use cases and feedback instructions are available for download by typing the following into your web browser:
If your organization would like to provide feedback for any of the prototype use cases, feedback may be submitted, preferably via e-mail to the following mailboxes no later than close of business, Friday, September 28th, 2007:
- Public Health Case Reporting - (usecase1@hhs.gov)
- Consultation and Transfers of Care - (usecase2@hhs.gov)
- Personalized Healthcare - (usecase3@hhs.gov)
- Immunizations & Response Management - (usecase4@hhs.gov)
- Remote Monitoring - (usecase5@hhs.gov)
- Remote Consultation - (usecase6@hhs.gov)
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WHITE PAPER ON THE IMPACT OF THE NPI (NATIONAL PROVIDER IDENTIFIER) ON THE PHARMACY SERVICES SECTOR USING THE NCPDP STANDARDS Article |
The NCPDP SNIP (Strategic National Implementation Process) Committee over a period of several months developed, in collaboration with The Workgroup for Electronic Interchange (WEDI) SNIP Committee and with final review and approval by the WEDI Board, The Impact of the NPI on the Pharmacy Services Sector Using the NCPDP Standards white paper. This paper focuses on the key issues that the pharmacy industry will need to address when working to implement the NPI using the NCPDP Standards. The paper also provides recommendations on the key issues to allow for a smooth transition to the NPI. Click Here for a copy of this paper as updated July 2007 and approved by the WEDI Board on August 23, 2007. In addition to this paper, several other white papers created by the WEDI SNIP Committee regarding NPI may be found at Other WEDI NPI White Papers.
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ONLINE JOB LISTINGS Article |
The member section of the NCPDP website includes an employment listing. NCPDP members can check out new opportunities. If your company has a position to fill, you can list your position for only $100. For information contact Kevin Steven at ksteven@ncpdp.org. To view the current job listings, click here.
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NCPDP TELECOMMUNICATION VERSION 5 DOCUMENT AVAILABLE Article |
The "Telecommunication Version 5 Questions, Answers, and Editorial Updates" is available on the NCPDP website on the HIPAA public or members only WG1 Telecommunication page. The document has been updated with a section on guidance for vaccine billing under Medicare Part D and examples of Service Billings for services without a medication. See the appendix of changes for the specific sections. To view the document, click here
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