Resources

TYPE









TOPIC
























Documents | Informational

Industry Acronym Dictionary

Industry Acronym Dictionary

If you would like to suggest an acronym, please send an email to NCPDP@ncpdp.org with subject line "Suggested Acronym".

Documents | Guides and Templates | Informational

ePrescribing Industry Information

ePrescribing Industry Information

Information about electronic prescribing, standards and reference material from the industry

Documents | Guides and Templates

SCRIPT Implementation Recommendations Document Version 1.68

SCRIPT Implementation Recommendations Document Version 1.68

This document provides requirements and best practice guidance for implementation when transmitting NCPDP SCRIPT transactions. This document also contains editorial corrections, clarifications to the NCPDP SCRIPT Implementation Guide documents.

Documents | Guides and Templates

HIPAA Information 

HIPAA Information 

This section contains information for the public about the Health Insurance Portability and Accountability Act of 1996 as it relates to the pharmacy industry.

Press Releases

NCPDP Announces Rockstar Mark Schulman - Drummer for P!NK - as Keynote Speaker for Its
2024 Annual Conference, “Innovation Starts Here”

NCPDP Announces Rockstar Mark Schulman - Drummer for P!NK - as Keynote Speaker for Its
2024 Annual Conference, “Innovation Starts Here”

World-class Musician Turned Motivator Who Has Worked with Other Legends Including Foreigner, Billy Idol and Cher Will Engage and Inspire Conference Attendees by Unlocking the Secrets to “Hacking the Rockstar Attitude”

Press Releases

NCPDP Announces Emmy-Winning David Pogue to Deliver Keynote Address for Its 2024 Annual Conference “Innovation Starts Here”

NCPDP Announces Emmy-Winning David Pogue to Deliver Keynote Address for Its 2024 Annual Conference “Innovation Starts Here”

CBS Sunday Morning Correspondent, NOVA Host & Former New York Times Columnist, Will Engage and Inspire Conference Goers in a Talk Blending Healthcare Tech Innovation with Powerful Storytelling

Documents | Guides and Templates

X12N 835 Payment Guidance and Related Documents - X12/N005010X221A1 Health Care Claim Payment/Advice (835) Questions and Answers Version 2.0
 

X12N 835 Payment Guidance and Related Documents - X12/N005010X221A1 Health Care Claim Payment/Advice (835) Questions and Answers Version 2.0
 

WG45 External Standards Assessment and Implementation Guidance’s revision of the X12/N005010X221A1 Health Care Claim Payment/Advice (835) Questions and Answers Version 2.0 was completed January 2024. The document provides answers to questions received by the task group and was updated to provide additional clarity to the questions and answers, to add more detailed field information and to align the document with the task group’s purpose.

Press Releases

NCPDP Foundation Announces $83,000 Grant to RxEOB.Com, LLC, Marking the Foundation’s First Grant Supporting Consumer Access to Real-time Data Using NCPDP Standards 

NCPDP Foundation Announces $83,000 Grant to RxEOB.Com, LLC, Marking the Foundation’s First Grant Supporting Consumer Access to Real-time Data Using NCPDP Standards 

The grant funding will be used to demonstrate the value of NCPDP standards in providing consumers with transparency and choice on prescription medications, while also providing payment assistance and discount options to lower out-of-pocket costs and improve medication adherence and outcomes.

Informational

Representative NDC Use in Electronic Prescribing Fact Sheet

Representative NDC Use in Electronic Prescribing Fact Sheet

This Fact Sheet has been created to assist in clarifying the use of the "representative NDC" as it relates...

Press Releases

NCPDP Foundation Awards $79,000 Grant to Digital Therapeutics Alliance to Address Key Barrier for Patient Access to Clinically Validated Digital Therapeutic (DTx) Products

NCPDP Foundation Awards $79,000 Grant to Digital Therapeutics Alliance to Address Key Barrier for Patient Access to Clinically Validated Digital Therapeutic (DTx) Products

Digital Therapeutics Alliance to research current obstacles or barriers to health plan coverage of DTx therapies and develop standardized pharmacy and medical benefit workflows to show how DTx products can be integrated into benefit designs.

Documents | Informational

NCPDP Precision Medicine Executive Summary

NCPDP Precision Medicine Executive Summary

An executive overview of the importance of a pharmacist led pharmacogenomic solution

Press Releases

Guides and Templates

NCPDP Processor ID (BIN)

NCPDP Processor ID (BIN)

The NCPDP Processor ID Number (BIN) is a six-digit number that health plans can use to process electronic pharmacy claims. Plans that use cards with a magnetic stripe should use the recommended American National Standards Institute (ANSI) Issue Identifier Number (IIN) for processing electronic pharmacy claims. ANSI issues IIN numbers. NCPDP issues the Processor ID Number (BIN). It is important to understand the difference between the IIN and NCPDP Processor ID Number (BIN) before applying for a Processor ID Number (BIN).

Documents

DERF and New Project Form Calendar

DERF and New Project Form Calendar

Current schedule for submitting and reviewing new DERFs and New Projects.

Documents | Guides and Templates

SPAP ADAP Resources

SPAP ADAP Resources

NCPDP, CMS, and the CMS Transaction Facilitator are continually enhancing processes to identify claims for TrOOP eligible State Pharmaceutical Assistance Programs (SPAPs) and AIDS Drug Assistance Programs (ADAPs).  Their goals are to help increase the likelihood that SPAP and ADAP claims are appropriately applied to the member’s TrOOP and that the appropriate entity is refunded or invoiced in the event of a copay/coinsurance adjustment.

News

Updated Guidance for SPAPs and ADAP

Updated Guidance for SPAPs and ADAP

NCPDP recently published an updated version of NCPDP Guidance for SPAPs and ADAPs Medicare Part D Coordination of Benefits Requirements and Responsibilities.

Documents

Data Element Request Form (DERF)

Data Element Request Form (DERF)

The Data Element Request Form (DERF) is the documentation used to request an addition or modification to an NCPDP standard. Anyone may submit a DERF to NCPDP along with accompanying information, including the proposed standard, implementation guide, data element dictionary, and modification log if needed. A DERF must be completed and submitted with the proper documentation prior to the next quarterly work group meetings for it to be reviewed during those meetings. The DERF is distributed to NCPDP members via the NCPDP website before the work group meeting.

Press Releases

NCPDP Announces Highlights from its 2023 Annual Conference, “The Great Race to Close Gaps in Care”

NCPDP Announces Highlights from its 2023 Annual Conference, “The Great Race to Close Gaps in Care”

Highlights Include Newly Elected Board Members, Announcement of Award Recipients, Keynoters and Featured Speakers Headlining the Conference, and Member-Exclusive Updates in the State of the Association Address

Informational

NCPDP Background & Organizational Structure - NCPDP University Course 100A

NCPDP Background & Organizational Structure - NCPDP University Course 100A

High level overview of NCPDP. Learn about NCPDP's Vision, Purpose, Core Values, Key Milestones in NCPDP's history, overview of membership categories, member awards, standards development overview, meetings and education, and NCPDP Products & Services.

Press Releases

NCPDP’s Lee Ann Stember Awarded APhA Honorary Membership at APhA Annual Meeting

NCPDP’s Lee Ann Stember Awarded APhA Honorary Membership at APhA Annual Meeting

Stember’s 40+ Year Career has Significantly Impacted the Pharmacy Profession and Supported the Expanding Role of Pharmacists

Press Releases

NCPDP Announces John O’Leary as Keynote Speaker for Its 2023 Annual Technology & Business Conference
 

NCPDP Announces John O’Leary as Keynote Speaker for Its 2023 Annual Technology & Business Conference
 

Severe Burn Survivor, Inspirational Speaker & Bestselling Author John O’Leary Will Engage and Inspire Conference Goers in a Powerful Keynote Address on May 9th

Documents | Guides and Templates

Medicare Part D

Medicare Part D

Medicare Part D and Payers Supplemental to Part D

Press Releases

NCPDP Announces Robin Farmanfarmaian as Keynote Speaker for its 2023 Annual Technology & Business Conference

NCPDP Announces Robin Farmanfarmaian as Keynote Speaker for its 2023 Annual Technology & Business Conference

Speaker, Author and Tech Entrepreneur, Robin Farmanfarmaian, Will Engage and Inspire Conference Goers in a Powerful Call to Action to Close Gaps in Healthcare

Guides and Templates

Specialty Pharmacy Resources

Specialty Pharmacy Resources

Summary of available resources related to specialty pharmacy.

Press Releases

NCPDP Announces Admiral Brett Giroir, M.D., as Opening Keynote Speaker for Its
2023 Annual Technology & Business Conference
 

NCPDP Announces Admiral Brett Giroir, M.D., as Opening Keynote Speaker for Its
2023 Annual Technology & Business Conference
 

NCPDP announced today the 16th Assistant Secretary for Health in the United States Department of Health and Human Services, Dr. Brett Giroir, whose impressive, decades-long career is dedicated to improving public health, will deliver the opening keynote at NCPDP’s 2023 Annual Technology & Business Conference, “The Great Race to Close Gaps in Care.”

Documents | Guides and Templates

X12N 835 Payment Guidance and Related Documents -  NCPDP Direct/Indirect Remuneration (DIR) 835 Reporting Recommendations

X12N 835 Payment Guidance and Related Documents -  NCPDP Direct/Indirect Remuneration (DIR) 835 Reporting Recommendations

WG45 External Standards Assessment, Harmonization and Implementation Guidance Work Group has created the NCPDP Direct/Indirect Remuneration (DIR) 835 Reporting Recommendations document. Payers may use this document to convey a consistent solution for identifying Direct and Indirect Remuneration (DIR) adjustments of pharmacy claims using the X12 005010X221A1 Health Care Claim Payment/Advice (835) to their provider business partners. The document should not be used as a standard form by a payer to provide information that is important to pharmacy providers, pharmacy reconciliation vendors and other implementation units.

Documents | Guides and Templates

X12N 835 Payment Guidance and Related Documents - Payer Audit Reporting Transaction 

X12N 835 Payment Guidance and Related Documents - Payer Audit Reporting Transaction 

WG45 External Standards Assessment, Harmonization and Implementation Guidance revision of the Payer Audit Reporting Transaction was updated January 2023. This document provides guidance to the pharmacy sector of the health care industry for reporting the outcome of a payer initiated post payment audit and adjustment of pharmacy claims using the X12/005010X221 Health Care Claim Payment/Advice (835).

News

Payer Audit Reporting Transaction Document Updated

Payer Audit Reporting Transaction Document Updated

The NCPDP Payer Audit Reporting of Pharmacy Claims on the X12 005010X221A1 Health Care Claim Payment/Advice guidance document (https://ncpdp.org/NCPDP/media/pdf/X12N835_5010AuditAdjustment.pdf) has been revised.

Documents

Standards Correspondence

Standards Correspondence

This page contains final correspondence generated by task groups, work groups, and the Standardization Committee. Web page; https://standards.ncpdp.org/Correspondence.aspx

Documents | Guides and Templates | Informational

NCPDP Emergency Preparedness Guidance v.1.16

NCPDP Emergency Preparedness Guidance v.1.16

2022 updates to the NCPDP Emergency Preparedness Guidance document

Documents | Guides and Templates | Informational

Emergency Preparedness

Emergency Preparedness

This page provides guidance to the pharmacy industry for resources available during a declared emergency. The intended audience is healthcare industry providers who would need resource information for eligibility and claims processing affecting displaced individuals.

Documents

Task Group Listing

Task Group Listing

Comprehensive listing of NCPDP active Task Groups

Press Releases

NCPDP Announces Pilot Launch of its National Facilitator Model to Strengthen Pandemic and Epidemic Preparedness & Response and Support Public Health Surveillance

NCPDP Announces Pilot Launch of its National Facilitator Model to Strengthen Pandemic and Epidemic Preparedness & Response and Support Public Health Surveillance

NCPDP announced today the pilot launch of its National Facilitator Model which can be used to provide real-time information on prescription, testing, immunization, and related data to pharmacies, prescribers and government agencies to aid in pandemic and epidemic response, proactive intervention and public health surveillance.

Documents | Guides and Templates

X12N 835 Payment Guidance and Related Documents - Low Income Subsidy (LIS) Reporting Transaction

X12N 835 Payment Guidance and Related Documents - Low Income Subsidy (LIS) Reporting Transaction

WG45 External Standards Assessment, Harmonization and Implementation Guidance revision of the Low Income Subsidy (LIS) Reporting Transaction was completed August 2012 and last updated October 2022. This document provides guidance to the pharmacy sector of the health care industry for reporting the outcome of a payer initiated retro-active Low Income Subsidy (LIS) adjustment of pharmacy claims using the X12/005010X221 Health Care Claim Payment/Advice (835) to their long term care (LTC) business partners.

Documents | Guides and Templates

X12N 835 Payment Guidance and Related Documents - Central Pay Transaction

X12N 835 Payment Guidance and Related Documents - Central Pay Transaction

WG45 External Standards Assessment, Harmonization and Implementation Guidance revision of the Central Pay Transaction was completed October 2014 and last updated October 2022. This document provides guidance to the pharmacy sector of the health care industry to convey a consistent solution for recovering overpayments from a Central Pay Prescription Service Administration Organization (PSAO) and/or financial intermediary via the X12/005010X221A1 Health Care Claim Payment/Advice (835).

Documents | Guides and Templates

X12N 835 Payment Guidance and Related Documents - NCPDP Pharmacy Reference Guide to the X12/005010X221 Health Care Claim Payment/Advice (835)

X12N 835 Payment Guidance and Related Documents - NCPDP Pharmacy Reference Guide to the X12/005010X221 Health Care Claim Payment/Advice (835)

WG45 External Standards Assessment, Harmonization and Implementation Guidance revision of the NCPDP Pharmacy Reference Guide to the X12/005010X221 Health Care Claim Payment/Advice (835) was completed May 2010 and last updated in March 2017. The NCPDP Pharmacy Reference Guide to the X12/005010X221 Health Care Claim Payment/Advice (835) document must be used in conjunction with the X12/005010X221 and does not supersede it. The reference document is meant to supplement the provider manuals that payers build. Payers can use this document to convey the important features of supporting the X12/005010X221 to their business partners.

Documents | Guides and Templates

NCPDP Emergency Preparedness Guidance 

NCPDP Emergency Preparedness Guidance 

This document provides resource information for the pharmacy industry for a declared emergency

Press Releases

NCPDP Announces Call for Proposals for its 2023 Annual Technology & Business Conference, “The Great Race to Close Gaps in Care”

NCPDP Announces Call for Proposals for its 2023 Annual Technology & Business Conference, “The Great Race to Close Gaps in Care”

NCPDP announced today the call for proposals for its 2023 Annual Technology & Business Conference, “The Great Race to Close Gaps in Care,” which will be held May 8-10, 2023, at the Westin Kierland Resort & Spa in Scottsdale, Arizona.

Documents | Guides and Templates

X12N 835 Payment Guidance and Related Documents - CARC Mapping Document

X12N 835 Payment Guidance and Related Documents - CARC Mapping Document

WG45 External Standards Assessment, Harmonization and Implementation Guidance Work Group has prepared a mapping document for consistent use of the Claim Adjustment Reason Codes (CARC), Claim Adjustment Group Codes (CAGC) and NCPDP Reject Codes in the X12 835.

Guides and Templates

Use of the BIN - NCPDP Processor ID

Use of the BIN - NCPDP Processor ID

The Bank Identification Number (BIN) is a term from the credit card industry. It refers to a six-digit number that is assigned to banks for electronic routing of transactions. Credit/debit cards that are involved in banking transactions contain a BIN on magnetic stripe. The term BIN is no longer supported. The number is now called an Issuer Identification Number (IIN). As of January 2017, the IIN length has changed from a 6-digit number to an 8-digit number. Existing six-digit IINs will be converted into a block of a hundred eight-digit IINs. As the majority of issuers are unlikely to need all one hundred of these, they are encouraged to return any unused eight-digit IINs to ANSI.

Guides and Templates

Issuer Identification Number - NCPDP Processor ID (BIN)

Issuer Identification Number - NCPDP Processor ID (BIN)

To obtain an IIN, please contact the American National Standards Institute (ANSI) www.ansi.org. On the ANSI web page, enter "IIN" in the Search box. Links will appear for the application process.  ANSI is responsible for making certain the application has been properly completed and that all appropriate fees and attachments have been collected.  Once verified, ANSI will submit the application to the ISO/IEC7812 Registration Authority for assignment of an IIN.

Guides and Templates

Processor Identification Number (Processor BIN) - NCPDP Processor ID (BIN)

Processor Identification Number (Processor BIN) - NCPDP Processor ID (BIN)

In approximately 1989 the pharmacy services sector began using electronic processing for pharmacy claims. This electronic processing of pharmacy claims meant the health plan (or their Pharmacy Benefit Manager/processor/payer on their behalf) needed a number for the electronic routing of transactions. Some health plans decided to use magnetic stripe cards, some did not. Those that use magnetic stripe cards apply through ANSI for an IIN. These numbers commonly begin with "61" as in "610014". Those health plans that did not have a business reason for creating pharmacy benefit cards with a magnetic stripe were in need of a number, because they still needed to process electronic pharmacy claims. NCPDP provides a service to those health plans that do not use magnetic stripe cards. The NCPDP Processor BIN is a six-digit sequential number we assign that begins with "0" as in "000010". We do not reuse numbers. There is a fee to obtain a number.

Documents | Guides and Templates

How to Obtain a Processor ID (BIN) - NCPDP Processor ID (BIN)

How to Obtain a Processor ID (BIN) - NCPDP Processor ID (BIN)

Contact NCPDP Provider Services Department at 480.734.2870 or PharmacyHelp@ncpdp.org, or complete a Processor ID Application. Your number will be assigned and notification will be delivered via fax or email.

Guides and Templates

IIN/Processor Identification Number (Processor BIN) Use - NCPDP Processor ID (BIN)

IIN/Processor Identification Number (Processor BIN) Use - NCPDP Processor ID (BIN)

When a patient requests a prescription to be filled at the pharmacy, the pharmacy collects pertinent information on their prescription benefit program. One piece of information is the name of the health plan/PBM. If the health plan uses the NCPDP Pharmacy ID and Combination Card Implementation Guide that NCPDP members have created, the BIN/IIN is clearly shown on the card. The pharmacy system then includes this BIN/IIN in the electronic transaction the pharmacy sends to the payer for the prescription. The BIN/IIN is a field in the Telecommunication Standard that is used for the routing and identification in pharmacy claims. The BIN/IIN field will either be filled with the ISO/IEC 7812 IIN or the NCPDP Processor BIN, depending on which one the health plan has obtained.

Documents | Guides and Templates | Informational

NCPDP Processor ID (BIN)

NCPDP Processor ID (BIN)

The NCPDP Processor ID Number (BIN) is a six-digit number that health plans can use to process electronic pharmacy claims if they do not use pharmacy benefit cards with a magnetic stripe. Plans that use cards with a magnetic stripe should use the recommended American National Standards Institute (ANSI)ISO/IEC 7812 Issuer Identifier Number (IIN) for processing electronic pharmacy claims. ANSI The ISO/IEC 7812 Registration Authority (the American Bankers Association) issues the IIN. numbers. NCPDP issues the Processor ID Number (BIN). It is important to understand the difference between the ISO/IEC 7812 IIN and NCPDP Processor ID Number (BIN) before applying for a Processor ID Number (BIN).

Documents | Guides and Templates | Informational

Pharmacy and Healthcare Identification Cards - Fact Sheet

Pharmacy and Healthcare Identification Cards - Fact Sheet

Guidance Document for Pharmacy and Healthcare Identification Cards-The document relates to the current NCPDP Health Care Identification Card Pharmacy ID Card Implementation Guide. The purpose of the fact sheet is to provide details about the NCPDP format and may be distributed to members and non-members. If you have any questions about the fact sheet, please contact Leslie Carr at the Council office at 480.477.1000 ext. 195

News

Kristol Chism, R.Ph., is announced as the 2022-2023 Emerging Professional Fellow

Kristol Chism, R.Ph., is announced as the 2022-2023 Emerging Professional Fellow

The Strategic Planning Committee (SPC) and Emerging Professionals Group is proud to announce Kristol Chism, R.Ph. with Change Healthcare as the incoming Emerging Professionals Fellow.

Documents | Informational

Get Familiar with NCPDP’s "Swim Lane Analysis"

Get Familiar with NCPDP’s "Swim Lane Analysis"

This is a tool being used to identify and explore possible ways to streamline processes in support of our strategic goal to increase the speed to standards creation.

White Papers

Facilitating Access to Specialty Products An NCPDP Review and Recommendations White Paper

Facilitating Access to Specialty Products An NCPDP Review and Recommendations White Paper

This paper offers recommendations to manufacturers, prescribers, payers and pharmacies regarding the information related to hub services and limited distribution products.

Press Releases

NCPDP Announces Recipients of its 2022 Champion Award

NCPDP Announces Recipients of its 2022 Champion Award

Lori Moore, PharmD, CAPT United States Public Health Service (USPHS), and Paloma L. Hawry, CDC Contractor, Deloitte Consulting | Federal Healthcare, are Recognized as NCPDP Champions

Press Releases

NCPDP Announces Highlights from its 2022 Annual Conference, “BE BOLD. Break Barriers.”

NCPDP Announces Highlights from its 2022 Annual Conference, “BE BOLD. Break Barriers.”

Highlights Include Newly Elected Board Members, Announcement of Award Recipients, Keynoters and Featured Speakers Headlining the Conference, and State of the Association Report