WG1 Telecommunication
Work Group 1 Telecommunication develops and maintains standard forms and guidelines to accommodate electronic pharmacy claim information at the point-of-service, i.e. administering and certifying eligibility, prior authorization, and prescribing drug benefits for traditional, managed care, and government programs; billing; payment or denial of compensation with explanations, and concurrent drug use review.
- Complete development of the Protocol Document.
- Complete task group work for Post Adjudicated History Reporting.
- Continue task group to provide guidance on Telecommunication Standard Version 5 Frequently Asked Questions.
- Continue task group to create a proposal of patient validation standard.
- Continue task group to create a standard for prior authorization transfers.
- Complete task group work to address coupon clarification.
- Provide Health Insurance Portability and Accountability Act (HIPAA) updates.
- Review Designated Standards Maintenance Organization Change Request System (DSMO CRS) as needed.
- Provide Workgroup for Electronic Data Interchange - Strategic National
Implementation Process (WEDI -SNIP) and NCPDP SNIP updates.
- Incorporate Protocol Document into the Telecommunication Standard.
- Provide a forum for implementation issues surrounding the Medicare Prescription Benefit 2006.
- Report from the WG9 Pricing and Balancing Task Group.
- Provide updates as needed from WG14 Long Term Care.
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WG2 Product Identification
Work Group 2 Product Identification deals with issues relating to the identification of drugs and health related products within NCPDP’s stated mission. Identification will consist of how the product is billed (billing units, quantity designations), product identification systems, and any type of descriptive data which serves to uniquely identify a product with the intent to establish standards for product identification such that there is no ambiguity in distinguishing one product from another.
- Develop communication plan for new Billing Unit Standard Implementation Guide Version 2.0 for NCPDP members and other impacted parties (such as government agencies, manufacturers).
- Educate and promote use of metric decimal quantity.
- Increase attendance and participation of manufacturers.
- Work with WG7 Manufacturer Rebates to increase cooperation between NCPDP and the Center for Medicare and Medicaid Services (CMS).
- Review and adjudicate Quantity Unit Information Communication (QUIC) Forms.
- Monitor and report on issues relating to scope on WG2 including but not limited to NCVHS, FDA, HL7 and Bar Code.
- Continuation collaboration with NCVHS and HL7.
- Develop a Manufacturer Guidance Form in conjunction with the use of the QUIC Form.
- Continue to work on the development of a Standard Reporting Package Size.
- Provide clarification and education on the structure of the National Drug Code (NDC), Universal Product Code (UPC), and the National Health Related Item Code (HRI) as they are formatted for use within the NCPDP standards.
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WG3 Standard Identifiers
Work Group 3 Standard Identifiers develops, educates, and promotes the adoption of standard identifiers for pharmaceutical data transactions, health care providers, and benefit delivery systems, i.e. identification cards.
- Pharmacy ID Cards
- Monitor any initiative to establish a universal healthcare ID card and respond appropriately.
- Continue to collaborate with the International Committee for Information Technology Standards (INCITS) to accommodate standard ID card changes, when necessary, to the NCPDP Pharmacy ID Card Implementation Guide.
- Monitor industry activity, as related to the adoption of the Pharmacy ID Card Implementation Guide and serve as an information source for parties interested in Pharmacy ID Card standardization.
- Monitor government action related to initiatives proposing the use of a standard ID card.
- Maintain the NCPDP Pharmacy ID Card Fact Sheet.
- Monitor, as appropriate, states or other entities attempting to ban the use of the Drug Enforcement Agency (DEA) number as the prescriber identifier for pharmacy transactions.
- Other Identifier Initiatives
- Monitor and respond to HIPAA National Health Plan ID NPRM when released.
- Work with other applicable work groups in support of identifier initiatives (examples: WG 12 Education – Legislation and Regulation and WG2 Product Identification).
- Monitor State and Federal legislation related to Subscriber/Individual Identifiers.
- Track HIPAA National Provider Identifier (NPI) activity and collaborate with the NCPDP SNIP Liaison Special Committee on responses to any initiatives.
- Maintain State of the States for Pharmacy ID Cards, Prescriber ID’s, Subscriber/Individual Identifiers and Discount ID Cards.
- NCPDP Pharmacy Database
- Provide input to NCPDP Staff on enhancing and maintaining the quality of the file, file layouts and field values, and implementation guide.
- Direct or assist in responding to inquiries regarding the NCPDP Pharmacy Database to appropriate NCPDP staff.
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WG7 Manufacturer Rebates
Work Group 7 Manufacturer Rebates develops, monitors and maintains standards for the electronic exchange of prescription-based rebate data between manufacturers and data providers, and/or trading partners. Additionally, the WG will facilitate the implementation and education of the rebate standard and process.
- The Standards Update Task Group, with the assistance of the Implementation Task Group, will revise the standard to include changes necessary to meet business needs and, if appropriate, incorporate new technologies and standards (i.e., Medicare Part D, NPI).
- Increase Manufacturer Rebate Standard use in the industry.
- The CMS Roundtable Task Group will work to develop programs to improve State Medicaid participation and implementation of NCPDP Rebate Standard.
- Increase WG7 participation in the following membership categories:
- Community pharmacy
- Pharmaceutical manufacturers
- Database management organizations
- Buying groups
- Pharmacy Benefit Managers (PBM)
- Government Programs, i.e., Medicaid, Medicare, Department of Defense, Veterans Administration
- Software vendors
- Develop and publish a Commercial Rebates Best Practices Document.
- Alliance with WG2 Product Identification and WG9 Government Programs to represent NCPDP at Industry Educational Programs.
- Coordinate with the Center for Medicare and Medicaid Services (CMS) to have the NCPDP Rebate Standard recognized as the standard.
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WG9 Government Programs
Work Group 9 Government Programs, in conjunction with Work Group 1 Telecommunication, guides and advises Federal and State funded pharmacy programs and their agents on standards implementation, supports data processing initiatives, and provides design alternatives for standards, which support government requirements.
- Maintain the State of the States (Medicaids).
- Work with Federal and State funded pharmacy programs as they implement the Health Insurance Portability and Accountability Act (HIPAA) named standards.
- Act as a resource for Medicaid Subrogation and Batch Standard implementation questions.
- Provide a forum for members to discuss the rollout of a Medicare Prescription Benefit, including the transition of duel eligible beneficiaries, wrap around drug coverage (or other drug coverage issues) and outreach in collaboration with NCPDP SNIP Liaison Special Committee.
- Provide a forum for members to discuss the Medicare Modernization Act and its impact on federal and state funded programs.
- Provide a forum for discussion on the billing of transactions by states.
- Review and recommend changes to implementation of the standards development process and regulatory process as related to HIPAA.
- Continue discussion and communication with CMS/HHS on the billing of Home Infusion Therapy.
- Collaborate with the National Medicaid HIPAA EDI (NMEH) on issues related to State Medicaids.
- Provide a forum for discussion of National Provider ID (NPI) as it applies to federal and state funded programs.
- Complete task group on Payer-to-Payer Transactions and Pricing/Balancing.
- Provide a forum for members to discuss the implementation of Average Sales Price (ASP) and Wholesale Selling Price (WSP).
- Complete a cross-walk of the ASC X12N 837 4010A1 to NCPDP Telecommunication Standard Version 5.1.
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WG10 Professional Pharmacy Services
Work Group 10 Professional Pharmacy Services assists in the development and maintenance of standards to support electronic documentation and transmission of data for professional pharmacy services.
- Recommend and participate in marketing and educational programs, including the Implementation Guides, Frequently Asked Questions, and the Protocol Document relating to the Clinical and DUR/PPS segments of Telecommunication Standard Version 5 and above; and support the SCRIPT Standard and other pharmacy-related standards.
- Monitor initiatives and, where necessary enhance current standards, related to on-line Drug Use Review (DUR) and Professional Pharmacy Services (PPS) and Medication Therapy Management Programs (MTM), relating to patient care and safety, and billing.
- Analyze and develop a standardized SIG.
- Provide support for the use of NCPDP Standards for Professional Pharmacy Services under HIPAA.
- Finalize the incorporation of the NCPDP v5.1 and On-Line Messages document and the ORDUR Applications Manual into the Telecommunication Implementation Guide, discontinuing these separate and distinct manuals; to enable a single reference for implementation issues surrounding DUR/PPS issues.
- Enhance current standards to incorporate additional clinical parameters captured from evolving technology.
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WG11 ePrescribing & Related Transactions
Work Group 11 ePrescribing & Related Transactions develops standardized messages for prescribers, pharmacists, payers and/or other interested parties to exchange information.
- Complete the development of the Prescription Transfer Standard – The transfer of prescriptions from one pharmacy to another – Retail or Mail Service.
- Seek out NCPDP members to attend and actively participate in WG11 ePrescribing & Related Transactions work group meetings.
- Encourage use of NCPDP SCRIPT Standard among NCPDP membership vs. non-standard interfaces.
- Monitor industry practices.
- Educate industry about benefits of using the NCPDP SCRIPT Standard.
- Remain informed of National Committee on Vital and Health Statistics (NCVHS) activities as they affect WG11.
- Continue collaboration with other organizations and Standards Development Organizations (SDO) activities as they affect WG11.
- Monitor Drug Enforcement Agency’s (DEA) activities for electronic initiatives of controlled substance prescriptions and electronic signature.
- Collaborate with WG10 Industry SIG Task Group and WG14 Long Term Care.
- Establish representatives from WG11 to participate in NCPDP SNIP Committee for the use of NPI in ePrescribing.
- Establish a task group regarding the use of RxNorm in the SCRIPT Standard and Formulary and Benefit Standard. Coordinate with WG2 Product Identification.
- Complete the development of the Provider Broadcast Standard.
- Continue progress on the Prior Authorization Workflow-to-Transactions Task Group.
- Continue working with NCVHS regarding the Medicare Prescription Drug Improvement, and Modernization Act of 2003 and its provision to “establish a real-time electronic prescribing program to be used by all physicians, pharmacies and pharmacists who serve Medicare beneficiaries with Part D benefits.”
- Collaboration on drug terminology with HL7, ASTM, and other organizations.
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WG14 Long Term Care
Work Group 14 Long Term Care, in conjunction with the other Work Groups, guides and advises payers and providers of the long term care industry and institutional pharmacy programs and their agents on standards implementation, supports data processing initiatives, and provides design alternatives for standards used within the long term care industry.
- Provide a forum to discuss enhancements to the Telecommunication Standard specific to the long-term care (LTC) pharmacy industry.
- In collaboration with the National Medicaid EDI HIPAA (NMEH), identify and resolve issues that relate to the LTC industry.
- Provide a forum to address the requirements of the LTC industry as they apply to the electronic standards (including SCRIPT) and, where needed, to suggest extensions of the standards.
- Provide a forum to develop standards specific to electronic transmission for Consultant Pharmacist Drug Regimen Review (DRR) federal requirements between the consultant pharmacist, nursing facility, provider pharmacy, Medical Director, and the physician.
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WG16 Property and Casualty/Workers' Compensation
Work Group 16 Property and Casualty/Workers' Compensation will ascertain, monitor and analyze regulatory requirements to develop correlating fields to be supported in the Telecommunication Standard format; evaluate, and maintain a Property and Casualty/Workers’ Compensation standard paper claim form; proactively promote and educate pharmacy industry stakeholders and regulatory policy makers on the form and format standards found in Property and Casualty/Workers’ Compensation (including but not limited to uniform billing, state reporting policies and the overall delivery of pharmacy services/care.
- Promote NCPDP membership attendance and active participation in work group meetings.
- Promote open and active participation by Work Group members in educating policy makers on issues pertinent to the delivery of pharmacy care/services for Workers’ Compensation/Property and Casualty (WC/PC) patients.
- Develop electronic claim solutions for current and future needs, within the Workers’ Compensation/Property and Casualty industries, not addressed in the NCPDP Telecommunication Standard Implementation Guide.
- Promote a national standard for pharmacy billing and reporting to Property and Casualty/Workers’ Compensation policy makers and stakeholders.
- Seek and promote solutions between stakeholders that may currently lack visibility and/or understanding about the pharmacy fulfillment and billing processes as it pertains to Workers’ Compensation/Property and Casualty.
- Modify the existing WC/PC Universal Claim Form and Reference Guide, as needed, for the Workers’ Compensation/Property and Casualty industries.
- Analyze and develop action plans regarding NCPDP formats to meet the needs of the Workers’ Compensation/Property and Casualty industries.
- Collaborate with other NCPDP work groups as needed.
- Monitor the task groups to ensure they are on track to complete their work. If appropriate, close task groups that have completed their work.
- Support the MC Education Legislation-and Regulation Task Group when new legislation is being introduced regarding issues relevant to the work group.
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WG17 Radio Frequency Identification/Auto ID (RFID)
Work Group 17 Radio Frequency Identification/Auto ID (RFID) identifies the intersection and gaps between RFID/Auto ID standards and health care industry requirements, and promotes the use of RFID/Auto ID through adherence to and enhancement of related standards.
- Define the business cases for use of RFID/Auto ID.
- Define content of the tag.
- Facilitate and support Patient Safety and Privacy.
- Facilitate the implementation of standards for identifying and tracking pharmaceuticals and other regulated products throughout the supply chain.
- Recommend cost effective implementation strategies.
- Promote the securing of data.
- In conjunction with Work Group12, track legislative and regulatory developments related to RFID/Auto ID and product tracking.
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WG45 External Standards Assessment, Harmonization and Implementation Guidance
Work Group 45 External Standards Assessment, Harmonization and Implementation Guidance reviews, assesses and works to continually monitor the development of standards by other Standards Development Organizations (SDOs) that may impact the pharmacy industry. WG45 communicates SDO developments and recommends actions needed by this or other NCPDP work groups. These include, but are not limited to, the X12N Implementation Guides and the Health Level Seven (HL7) Standards. Work Group 45 External Standards Assessment, Harmonization and Implementation Guidance develops and maintains guidelines for the pharmacy industry to accommodate pharmacy implementation of the Health Insurance Portability and Accountability Act (HIPAA) mandated electronic data interchange (EDI) transactions not developed by NCPDP as determined by the membership. To this end, Work Group 45 External Standards Assessment, Harmonization and Implementation Guidance will collaborate with other SDOs to provide the pharmacy perspective and represent the industry needs in the development of standards and guidelines.
- Promote NCPDP membership attendance and active participation in work group meetings.
- Discuss and/or present the needs of NCPDP members in the ongoing maintenance of non-NCPDP developed Health Insurance Portability and Accountability (HIPAA) mandated and other transaction data set standards. These standards include but are not limited to the following Accredited Standards Committee (ASC) X12N HIPAA mandated transaction data set standards:
- 274 Electronic Provider Enrollment Standard
- 834 Provider/Member Enrollment Standard
- 835 Payment Reconciliation Standard
- 270/271 Health Care Eligibility/Benefit Inquiry/Response
- 278 Health Care Services Review Request/Response
- Provide regular updates to Work Group 8 Government Programs regarding the implementation of the ASC X12 835.
- Continue progress on the following task groups:
- Central Pay
- 834 FAQ
- 835 FAQ
- Document Revision
- Net Retro-Eligibility Task Group
- 835 White Paper Guidance
- Monitor the task groups to ensure they are on track to complete their work. If appropriate, close task groups that have completed their work.
- Support the MC Education-Legislation and Regulation Task Group when new legislation is being introduced regarding issues relevant to the work group.
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MC Maintenance and Control
MC Maintenance and Control monitors and maintains the development of NCPDP standards, promotes consistent business and technical administration, makes recommendations to the Standardization Co-Chairs on development procedures, due process compliance, as well as ethical and legal controversies. MC provides a forum for resolution of inter-Work Group issues.
- Continue participation and collaboration in Designated Standards Maintenance Organization (DSMO) Change Request System (CRS) process
- Continue collaboration with Health Informatics Standards Board (HISB), US Health Information Knowledgebase (USHIK), Health Level Seven (HL7), ASC X12, and other external organizations.
- Review New Project Development requests and make recommendations to the Standardization Co-Chairs.
- Provide a forum for updates of WG activities.
- Review and recommend changes to the implementation of the standards development process and regulatory process as related to HIPAA.
- Create a task group to review Data Dictionary values and create definitions where needed.
- Continue to maintain the External Code List (ECL) and Data Dictionary.
- Create and maintain NCPDP sponsored Unified Modeling Language (UML) information models for the purposes of information model comparisons and collaborations with external organizations.
- Monitor and report on the WEDI Cost Benefit Analysis Task Group
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