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.
NCPDP Guidance for SPAPs and ADAPs Medicare Part D Coordination of Benefits Requirements and Responsibilities
This document provides guidance for SPAPs and ADAPs in exchanging data with Medicare Part D Plan Sponsors for electronic coordination of benefits.
BIN/PCN Spreadsheet Reference Guide
The NCPDP SPAP ADAP BIN PCN Reference Guide Updated: 201604 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.
SPAP ADAP BIN PCN Spreadsheet
The sharing of BINs and PCNs is via a simple spreadsheet that contains minimal information to assist the industry. The file layout has both operational and financial information. The spreadsheet is used to assist with the identification of ADAP and SPAPs but is not meant to be an all-inclusive list of all TrOOP eligible qualified payers to drive claims processing. This list can be used by Part D sponsors in reconciliation efforts along with managing TrOOP for their beneficiaries.
Update Date: 20190225 SPAP ADAP BIN PCN Spreadsheet
This information must be reviewed yearly or whenever data is updated by the SPAP or ADAP. The BIN, PCN, Coverage and/or Termination Dates reported must be the same data reported to CMS.
NCPDP manages this listing of State SPAPs and ADAPs. Additions or updates to the BIN/PCN Additions or updates to the BIN/PCN Spreadsheet are to be sent to NCPDP at: CMS-SPAP-ADAPplaninfo@ncpdp.org
Note: The SPAP/ADAP information contained in the spreadsheet is self-reported to NCPDP; consequently it may not be up to date. However this spreadsheet can continue to be utilized until a better solution can be determined.
RelayHealth, CMS Transaction Facilitator Presentations and References
201212 January 2012 SPAP/ADAP Supplemental Claims Data Review presentation
201504 Supplemental Payer N Transaction Reports
Supplemental Payer Batch N Transaction Information
Supplemental Payer Batch N Transactions can be submitted to RelayHealth by SPAPs or ADAPs that are not processing claims online, are not using a switch, or have made internal adjustments to their claims outside of the pharmacy. These batch Information Reporting transactions are forwarded to the Part D plan of record for date of service if they can be matched.
Click here for more information on batching N transactions.