There are inherent delays in the data availability and thus it is possible that a State Pharmaceutical Assistance Program (SPAP) or AIDS Drug Assistance Program (ADAP) may be paying claims for a beneficiary but the data has not yet been submitted or uploaded to the CMS systems. To mitigate this situation, CMS and the Transaction Facilitator have developed a process to increase the likelihood that these SPAP and ADAP claims are appropriately applied to the member’s TrOOP and that the appropriate entity is refunded in the event of a copay/coinsurance adjustment. NCPDP, with CMS and the Transaction Facilitator have developed a process to assist in sharing RxBIN and RxPCN for SPAPs and ADAPs.
The sharing of BINs and PCNs is via a simple spreadsheet that contains minimal information to assist the industry. Updated: 20130530
SPAP ADAP BIN PCN Spreadsheet Note new columns were added in January to capture information about plans that only use batch processing methods. A new tab was added in April to support sharing of financial contact information.
BIN/PCN Spreadsheet Reference Guide
The NCPDP SPAP ADAP BIN PCN Reference Guide Updated: 201204 provides instructional information for the process to update and share BINs and PCNs for SPAPs and ADAPs for transaction processing for Medicare Part D beneficiaries. This sharing of routing identifiers (BINs and PCNs) is done to facilitate the correct processing of pharmacy benefit claims for patient care.
201112 NCPDP Webinar for Plans Supplemental to Part D
201206 ADAPs and Medicare Part D Presentation
Supplemental Claims Data Review from RelayHealth, Transaction Facilitator
January 2012 SPAP/ADAP Supplemental Claims Data Review presentation
April 2012 Review
Recommendations for Effective 4Rx Usage in Medicare Part D Processing
NCPDP Medicare Part D Plans Moving Processors White Paper
Batch N Transaction Request File Format
The CMS Transaction Facilitator has requested the following information be made available to SPAP and ADAP entities that need to submit Information Reporting transactions to the Facilitator via a batch format. These batch Information Reporting transactions are then delivered to the CMS Part D plan if the 4Rx can be matched. Updated: 20120416 Batch Format FTP Information