Ncpdp fields. Payer Usage Payer Situation .

Ncpdp fields August 2024 National Council for Prescription Drug Programs 9240 East Raintree Drive Scottsdale, AZ 85260 Phone: (480) 477-1000 Fax: (480) 767-1042 Email: ncpdp@ncpdp. With the launch of Online NCPDP Universal Claim Forms may be purchased from our vendor, CommuniForm LLC. 4Ø2-D2 PRESCRIPTION/SERVICE REFERENCE NUMBER M NCPDP Facilitates Industry Creating new transactions • • Compatible with emerging technology • No pilots • HIPAA use of X12 278 and Telecom Standard Property of NCPDP 3 NCPDP SCRIPT 2013 published Standard includes ePA transactions • Educational sessions • Implementations begin/continue NCPDP Revises Transactions Field # NCPDP Field Name Value Payer Usage Payer Situation 1Ø1-A1 BIN NUMBER (see above) M 1Ø2-A2 VERSION/RELEASE NUMBER DØ M 1Ø3-A3 TRANSACTION CODE B1, B3 M 1Ø4-A4 PROCESSOR CONTROL NUMBER See above M Required for all claims 1Ø9-A9 TRANSACTION COUNT Up to 4 M 2Ø2-B2 SERVICE PROVIDER ID QUALIFIER 01 M NPI States should report values populated in the two NCPDP fields using the corresponding T-MSIS valid values. The system will not allow you to leave a required field blank; it will let you know if you do. Payer Usage Payer Situation : 304-C4 DATE OF BIRTH R CCYYMMDD 305-C5 PATIENT GENDER CODE R 310-CA PATIENT FIRST NAME R 311-CB PATIENT LAST NAME R 322-CM . Required for some federal programs, when NCPDP Universal Claim Forms may be purchased from our vendor, CommuniForm LLC. 4Ø2-D2 PRESCRIPTION/SERVICE REFERENCE Mandate for updated versions of NCPDP’s SCRIPT and Formulary &Benefit Standards and the newly- named NCPDP RTPB Standard supports interoperability, improves efficiencies, and includes transactions for better informed clinical decision-making at the point of care to improve the healthcare experience for patients and providers; Register to learn from the experts – ODM Companion Guide – NCPDP D. Please see important information regarding Quantity Prescribed field implementation. Field # NCPDP Field Name Value Payer Usage Payer Situation 1Ø1-A1 BIN NUMBER 022188 M 1Ø2-A2 VERSION/RELEASE NUMBER DØ M 1Ø3-A3 TRANSACTION CODE B1, B3 M 1Ø4-A4 PROCESSOR CONTROL NUMBER PSTMEDD (Medicare) M 1Ø9-A9 TRANSACTION COUNT Ø1 M 2Ø2-B2 SERVICE PROVIDER ID QUALIFIER Ø1 (NPI) M It highlights how to best utilize the NCPDP Telecommunication Standard Version D. NCPDP requests six months of CERT testing be allowed (July-December 2024). Permission is given to Council members Standard supports the fields for the billing of professional services and is allowed under HIPAA regulation for pharmacy service billing. NOTICE: In addition, certain NCPDP standards contain certain data fields and elements that may be completed by users with the proprietary information of third parties. The sign is internal and trailing; zero is always positive; field is always right-justified; and field contains a zero-filled dollar-cents amount with two positions to the right of the implied decimal point. 0 Payer Sheet Medicare . 0 published November 2012. transmitting NCPDP SCRIPT transactions. It is important that you update your pharmacy’s information with NCPDP. This document also provides important information needed for analysis and planning, and resource links. • Date is represented as YYYY-MM-DD • DateTime is represented as YYYY-MM-DDTHH:MM:SS Field # NCPDP Field Name Value Payer Usage Payer Situation 1Ø1-A1 BIN NUMBER ØØ9513 M 1Ø2-A2 VERSION/RELEASE NUMBER D. This document also contains editorial corrections, clarifications to the NCPDP SCRIPT Implementation Guide documents. NCPDP has maintained accurate pharmacy informationfor over 30 years. The use and distribution of third parties' propr ietary informatio n without such third parties' new fields and retire the old tag. NCPDP Implementation Overview - NCPDP has created this document to provide summary information of the transactions requested in the next round of HIPAA. • Enter GROSS AMOUNT DUE (NCPDP field # 430-DU) for entire product. 0 standard in 2012 . Field # NCPDP Field Name Value Payer Usage Payer Situation . When a claim is a compound, unit of measure should be reported from field 451-EG COMPOUND DISPENSING UNIT FORM Field # NCPDP Field Name Value Payer Usage Payer Situation 455-EM PRESCRIPTION/SERVICE REFERENCE NUMBER QUALIFIER of 1 = Rx Billing M Imp Guide: For Transaction Code “B1,” in the Claim Segment, the Prescription/Service Reference Number Qualifier (455-EM) is “1” (Rx Billing). 4Ø2 their definitions, formats, field size, applicable NCPDP standard(s) use, examples, field use limitations, comments and the existence of associated values. The use and distribution of third parties' proprietary information . 309-C9 ELIGIBILITY CLARIFICATION CODE Q Field # NCPDP Field Name Value Payer Usage Payer Situation 1Ø1-A1 BIN NUMBER 018117 M Medicare Part D Bin 1Ø2-A2 VERSION/RELEASE NUMBER DØ M 1Ø3-A3 TRANSACTION CODE B1, B3 M 1Ø4-A4 PROCESSOR CONTROL NUMBER MRXMED M Valid PCN required 1Ø9-A9 TRANSACTION COUNT 1 M Only 1 transaction for transmission for Medicare Part D NCPDP Telecommunication Standard Implementation Guide vD. • NCPDP dataQ™ - provides healthcare stakeholders with up-to-date, comprehensive, and in-depth pharmacy information. 11 FILLER. 0 as it applies to the Implementation of Medicaid Reimbursement Methodologies Based on Actual Acquisition Cost (AAC) Plus a (408-D8) field values to inform pharmacies of formulary requirements. 2. Version D Editorial Document v66 Version D Editorial Document v66. ncpdp. Permission is given to Council members to copy and use the work or any part thereof in connection with the business purposes of the Council members. However, they must contain values that conform to the NCPDP standard. Required 1 = Cardholder . Doing so is vital to proper reimbursement by many third-party plans. was developed to meet the industry In addition, this NCPDP Standard contains certain data fields and elements that may be completed by users with the proprietary : information of third parties. The VSAC value set is a queried subset of the Systematized Nomenclature of Medicine-Clinical Terms® (SNOMED CT®). NCPDP pioneered real-time claims adjudication at the point of service, electronic transmission of prescriptions, point-of-care access to patient medication history, and computerized order entry and results reporting for pharmacy *Field 524-FO will be used when the Health Plan ID is enumerated and will be populated in this field. A change require comments in the may field/value limitation columns if the change impacts the functionality of the Standard(s) in which the field resides. 00), a compounding fee will not be reimbursed. A Field # NCPDP Field Name Value Payer Usage Payer Situation 1Ø1-A1 BIN NUMBER See Above M 1Ø2-A2 VERSION/RELEASE NUMBER DØ M 1Ø3-A3 TRANSACTION CODE B1, B3 M 1Ø4-A4 PROCESSOR CONTROL NUMBER See Above M 1Ø9-A9 TRANSACTION COUNT Up to 4 M 2Ø2-B2 SERVICE PROVIDER ID QUALIFIER Ø1 M NPI ONLY Field # NCPDP Field Name Value Payer Usage Payer Situation 5Ø4-F4 MESSAGE S Imp Guide: Required if text is needed for clarification or detail. 1 the field Patient Location Code (3Ø7-C7) existed and contained values for both places of service and patient residence. 340-7C Other Payer Id Required if other insurance information is available for coordination of benefits. Transaction Clinical Segment Transaction Clinical Segment NCPDP publishes the following three types of documents: Standard Implementation Guide Data Dictionary External Code List The Data Dictionary contains the actual field descriptions, sizes, formats, comments, and usage instructions Which Data Dictionary do I use? Field # NCPDP Field Name Value Payer Usage Payer Situation 1Ø1-A1 BIN NUMBER 011891 M 1Ø2-A2 VERSION/RELEASE NUMBER DØ M 1Ø3-A3 TRANSACTION CODE B1- Claim M 1Ø4-A4 PROCESSOR CONTROL NUMBER System Vendor ID M Processor Control Number for Catamaran/Optum 1Ø9-A9 TRANSACTION COUNT 1,2,3, 4 M Accept up to 1 to 4 Mandate for updated versions of NCPDP’s SCRIPT and Formulary &Benefit Standards and the newly- named NCPDP RTPB Standard supports interoperability, improves efficiencies, and includes transactions for better informed clinical decision-making at the point of care to improve the healthcare experience for patients and providers; Register to learn from the experts – Claim Segment: Associated Prescription/Service Reference Number (NCPDP Field 456-EN). The authorization number is missing, invalid, or does not apply to the billed services or You can credential your existing NCPDP profile as of any date in which you have done a thorough review of the data on your NCPDP profile to insure that all fields are accurate and up to date. Pharmacy Login. National Council for Prescription Drug Programs (NCPDP) Reject Code “7C”- (Missing/Invalid Other Payer ID Code). – In XML, the Date fields contain the format of date and time, with hyphens to separate the subsets of the date. numeric, alpha/numeric, dollar). Claim Segment: Product/Service ID (NCPDP Field 4Ø7-D7). (460-ET) in NCPDP Telecommunication Standard Version D. 443-E8 Other Payer Date Required if identification of the Other Payer Date is necessary for claim/encounter adjudication. The definition of the field and the field format are listed. 0, External Code List (ECL) and Data Dictionary are available for NCPDP members to download from the NCPDP website (https://www. 17 This document provides resource information for the pharmacy industry for a declared emergency. • The DD contains the data elements by name and ID (when applicable) used within NCPDP standards and their definitions, formats, field size, applicable NCPDP standard(s) use, examples, field use limitations, comments and the existence of associated values. Because the NCPDP standards maintenance process Changes tothe fields/values contained in the ECL generate a new releaseof the ECL (no more than quarterly) . You can credential your existing NCPDP profile as of any date in which you have done a thorough review of the data on your NCPDP profile to insure that all fields are accurate and up to date. When a claim is a standard pharmacy claim, unit of measure should be reported from field 600-28 UNIT OF MEASURE. (UCF Field 81) and/or other currency fields. All pharmacies must complete all required fields and affirm their full Online NCPDP Pharmacy Profile by December 31, 2017 to ensure their NCPDP Number remains active and current. Here is the list of all fields for reference purposes. 1Ø1-A1 BIN NUMBER See Above M 1Ø2-A2 VERSION/RELEASE NUMBER DØ M 1Ø3-A3 TRANSACTION CODE B1, B3 M 1Ø4-A4 PROCESSOR CONTROL NUMBER See Above M 1Ø9-A9 TRANSACTION COUNT Up to 4 M 2Ø2-B2 The following lists the segments and fields in a Claim Billing or Claim Rebill Transaction for the NCPDP Telecommunication Standard Implementation Guide Version D. Patient Segment - Mandatory Field # NCPDP Field Name Value Payer Usage 111-AM Segment Identification Ø1=Patient M 331-CX Patient ID Qualifier O NCPDP Standards-based Facilitated Model for PDMP: Phase I and II An Interoperable Framework for Patient Safety Version 12 NOTICE: In addition, this NCPDP® Standard contains certain data fields and elements that may be completed by users with the proprietary information of third parties. C. NCPDP Resources, Press Releases, White Papers, Documents, Annual Reports. 1. Ø M 1Ø3-A3 TRANSACTION CODE B1 Billing B2 Reversal B3 Re-bill E1 Eligibility Verification M 1Ø4-A4 PROCESSOR CONTROL NUMBER P079009513 M 1Ø9-A9 TRANSACTION COUNT Ø1 = One information and should utilize the standards accordingly. Transaction Header Segment Claim Billing/Claim Rebill Field # NCPDP Field Name Value Payer Usage Payer Situation 101-A1 BIN NUMBER 610770 M [NCPDP Field ID 479-H8]) must be completed to receive reimbursement for a compounding fee. NCPDP EMERGENCY PREPAREDNESS GUIDANCE VERSION 1. 4Ø2-D2 PRESCRIPTION/SERVICE REFERENCE Field # NCPDP Field Name Value Payer Usage Payer Situation 455-EM Imp Guide: For Transaction Code PRESCRIPTION/SERVICE REFERENCENUMBER QUALIFIER 1 = Rx Billing M of “B1,” in the Claim Segment, the Prescription/Service Reference Number Qualifier (455-EM) is “1” (Rx Billing). Field # NCPDP Field Name Value Payer Usage Payer Situation Pricing Segment Questions Check Claim Billing/Claim Rebill If Situational, Payer Situation This Segment is always sent X Pricing Segment Segment Identification (111-AM) = “11” Claim Billing/Claim Rebill Field # NCPDP Field Name Value Payer Usage Payer Situation ncpdp@ncpdp. Claims will reject for NCPDP En-M/I Associated Prescription/Service Ref Number. Response Insurance Segment Segment Identification (111-AM) = “25” Claim Billing/Claim Rebill – Accepted/Paid (or Duplicate of Paid) Field # NCPDP Field Name Value Payer Usage Payer Situation Field # NCPDP Field Name Value Payer Usage Payer Situation 455-EM Imp Guide: For Transaction Code PRESCRIPTION/SERVICE REFERENCE NUMBER QUALIFIER 1 = Rx Billing M of “B1,” in the Claim Segment, the Prescription/Service Reference Number Qualifier (455-EM) is “1” (Rx Billing). A valid date not greater than the submission date must be indicated in this field. users with the proprietary information of third parties. The use and distribution of third parties' proprietary information without such third parties' consent, or the execution of a license or other agreement with such third party, could subject the user to numerous legal claims. The field cannot be left blank. Trading partners should consider other downstream processes and data exchanges that may be impacted or may not support these larger dollar amounts. NCPDP Telecommunications Standard D0 format serializer / parser - apiv/dzero. 0 Segment types. xml ¢ ( Ì•Ûjã0 †ï ú F·%VÚeYâô¢‡Ën¡Ý P¥I,¢ šIš¼ýŽ•¦,K ˜ Ú [žÿûGcÍLnÖÞU+ÈhchÄU= óFüyy ý ’ F¹ @q3½ø6yÙ$ÀŠ£ 6¢%J¿¤DÝ‚WXÇ Wf1{Eü˜ç2)½Ps ×ãñ ©c 4¢NCL'w0SKGÕýš_o ¼Ú ªÛíw ª *%gµ"6*WÁü ÅÙÌj0Q/=Kט2(ƒ-yW§l™˜Ÿ ˆ C!÷238ì }ϪæÈb [›ð’S?@XñÊ9Yqü]VoœÃ @‡> x7ö›ë Field # NCPDP Field Name Value Payer Usage Payer Situation 1Ø1-A1 BIN NUMBER (see above) M 1Ø2-A2 VERSION/RELEASE NUMBER DØ M 1Ø3-A3 TRANSACTION CODE B1, B3 M 1Ø4-A4 PROCESSOR CONTROL NUMBER See above M Required for all claims 1Ø9-A9 TRANSACTION COUNT Up to 4 M 2Ø2-B2 SERVICE PROVIDER ID QUALIFIER 01 M NPI . Submitted Final Ingredient Cost [NCPDP Field 409D9] plus applicable network- Dispensing Fee plus submitted or applicable Level of Effort professional allowance 3. Field Name – The short definition, name, or literal constant of the data located within the transaction at the positions indicated. A = Alphanumeric – Always left–justified and space filled; A –Z, 0–9, and printable characters. 2) Pharmacy Price Concessions at POS “In light of the changes to the treatment of pharmacy SEE PLAN BENEFIT OVERRIDE FIELDS IN RESPONSE CLAIM SEGMENT ADDITIONAL DOCUMENTATION . Provider will be paid [communicated in the NCPDP Field509-F9] lesser of the following three values: 1. • Enter QUANTITY DISPENSED (NCPDP field # 442-E7) of entire product. A NOTICE: In addition, this NCPDP Standard contains certain data fields and elements that may be completed by users with the proprietary information of third parties. when the Quantity Prescribed (460-ET) field would be used, alignment with the HIPAA process and the Transactions and Code Sets Rule, and an appropriate implementation timeline. Field # NCPDP Field Name Value Payer Usage . 0 Payer Specifications | Page 5 Claim Segment Segment Identification (111-AM) = “Ø7” Claim Billing/Claim Re-bill Field # NCPDP Field Name Value Payer Usage Payer Situation Date 09/21/2020. PK !§ÉÝÍ® ñ [Content_Types]. 610719 . The use and distribution of third parties' proprietary information without such third parties' NYRx is committed to making this transition as smooth as possible. Include a definition of the field. (505-F5) The date of death precedes the date of service. 2 Header and Trailer records are in a fixed-format standard. org NCPDP webinars provide timely insight on critical healthcare business issues, compliance with ever-changing healthcare regulations, and successful implementation of NCPDP standards to realize their full benefit. • Enter COMPOUND CODE (NCPDP field # 406-D6) of “2”. (ex: claim_segment[: list of ncpdp fields 1 list of ncpdp fields nov 16,2011 08:49 page 1 ncpdp field number ncpdp field name ----- 101 bin number 102 version/release number 103 transaction code 104 processor control number 109 transaction count 110 software vendor/cert id 111 segment Field # NCPDP Field Name Value Payer Usage Payer Situation 3Ø2-C2 CARDHOLDER ID M Patient Segment Questions Check Claim Billing/Claim Rebill If Situational, Payer Situation This Segment is always sent X Patient Segment Segment Identification (111-AM) = “Ø1” Claim Billing/Claim Rebill Field# NCPDP Field Name Value Payer NCPDP/X12 jointly developed an implementation guidance document on the sharing of pharmacy inventory data among stakeholders using the X12 852 Product Activity Report Specification. The X12 852 transaction set is used to advise a trading partner of inventory, sales, NCPDP Comment: NCPDP is requesting the field be named Originally Prescribed Quantity to align with the NCPDP field 446-EB in the Data Dictionary. 0 data element identifier for a given transaction. D NCPDP standards must not be used outside the United States without the express written certain NCPDP standards contain certain data fields and elements that may be completed by users with the proprietary information of third parties. If this field is left blank (or left at a value of $0. The Proper Use of the NCPDP Telecommunication Standard Version D. Version 2024. org). The work may not In addition, this NCPDP Standard contains certain data fields and elements that may be completed by . We bring diverse stakeholders together to improve the exchange of healthcare information for patients and everyone involved in delivering care. org, and protected by the copyright laws of the United States. The use and distribution of third parties' proprietary information without such third parties' consent, The NCPDP standard contains a 500-position field in the Prior Authorization Segment (498-PP Prior Authorization Supporting Documentation) that supports one occurrence of narrative information. Retail pharmacies must use this narrative field to submit the following information relating as required for Field # NCPDP Field Name Value Payer Usage Payer Situation . 02 through v07. Version D Field # NCPDP Field Name Value Payer Usage Payer Situation . Sterilization Fees Incentive Amount Submitted (NCPDP Field ID 438-E3) • Enter PRODUCT CODE/NDC (NCPDP field # 407-D7) as “00000000000” on the claim segment to identify the claim as a multi-ingredient compound. Title: South Carolina Reference Guide Coordination of Benefits Apply for new NCPDP / NPDS numbers; View and update your NCPDP profile information; Report changes in ownership to NCPDP; Did you know CMS requires that all Medicare Part D plans send pharmacy drug event data from claims to CMS. Mandate for updated versions of NCPDP’s SCRIPT and Formulary &Benefit Standards and the newly- named NCPDP RTPB Standard supports interoperability, improves efficiencies, and includes transactions for better informed clinical decision-making at the point of care to improve the healthcare experience for patients and providers; Register to learn from NCPDP Resources, Press Releases, The Excel document maps the Pharmacy ID Card data fields to the fields in the ASC X12N 270/271 transaction to give the industry guidance on where the fields should be populated should an NCPDP standard-based pharmacy ID card be presented to a prescriber who uses the X12N 270/271 standard to verify eligibility. Use CARC Code 16 with appropriate NCPDP Reject Code value(s) The date of birth follows the date of service. NEW DATA ELEMENT - Use this section to indicate the proposed field name, the size (length, including decimals, if applicable), and the format (e. Type field within the Request Coordination of Benefit Segment reports Adjudicated Program Type the (A28-ZR) field as returned by the previous payers’ response(s). • NCPDP standards are used in pharmacy processes, payer processes, electronic prescribing, rebates, and more. The repurposing of the field tag with a new field name, definition and code list caused confusion in the industry. 0 Payer Specifications Page 7 Patient Segment Segment Identification (111-AM) = “Ø1” Claim Billing/Claim Re-bill Field NCPDP Field Name Value Payer Usage Payer Situation 335-2C PREGNANCY INDICATOR RW Imp Guide: Required if pregnancy could result in different coverage, pricing, or The NCPDP Committee has now created a new field for the deductible and co-insurance qualifiers for use within the NCPDP D. With the launch of Online when the Quantity Prescribed (460-ET) field would be used, alignment with the HIPAA process and the Transactions and Code Sets Rule, and an appropriate implementation timeline. When time is used, a “T” separates the fields; and colons separate the subsets of the date and time. 2Ø2-B2 SERVICE PROVIDER ID QUALIFIER 01 = National Provider ID. 0 Version 13 May 2021 The purpose of this paper is to provide information and guidance on the use of the Quantity Prescribed (460-ET) field to address the issues with state requirements related to CII’s for dispensing of medication in increments less than the amount prescribed. NCPDP Version D. PATIENT STREET ADDRESS : RW . Must populate NDC for non- NCPDP Telecommunications Standard D0 format serializer / parser - apiv/dzero. 34ØB Information Exchange Reference Guide. NCPDP Part 2 Training Guide V1. 0 Editorial Document). To prepare for the update, NYRx encourages providers to review their software needs to accommodate the following NCPDP fields: All Pharmacy Providers: Use of NCPDP field 438-E3 (Incentive Amount Submitted) will be utilized for administration fees. Overpunch (0 - 9) - A signed numeric with implied decimal position. The result: consensus-based standards that connect healthcare electronically, streamline the Prior Authorization Segment fields are present Segment no longer valid for the Billing Transaction. 0 Payer Specifications Page 5 Patient Segment Segment Identification (111-AM) = “Ø1” Claim Billing/Claim Re-bill Field NCPDP Field Name Value Payer Usage Payer Situation 335-2C PREGNANCY INDICATOR RW Imp Guide: Required if pregnancy could result in different coverage, pricing, or patient financial responsibility. 128 - their definitions, formats, field size, applicable NCPDP standard(s) use, examples, field use limitations, comments and the existence of associated values. Payer Usage Payer Situation . Field will be right justified and filled with 5 leading zeroes. ForwardHealth enforces the submission of an other payer date in NCPDP field 443-E8 (Other Payer Date) when the COB segment is present. You can search on active or inactive NCPDPs or both. Without clarification and a better understanding on how this field is intended to work, NCPDP is unable to make a recommendation. 4Ø3-D3 FILL NUMBER R 4Ø5-D5 DAYS SUPPLY R 4Ø6-D6 COMPOUND CODE R ncpdp@ncpdp. The NCPDP 0B Information Exchange Reference Guide34 was developed to meet the industry needs for electronic communication between trading partners of an individual prescription or NCPDP standards must not be used outside the United States without the express written permission of NCPDP. 0. seq. National Council for Prescription Drug Programs White Paper. 1 to D0 Comparison Document for the fields in other segments that will replace the functionality of the fields in this segment. 0, published August 2007, has not changed and is still the HIPAA -named version of the standard. Caterpillar NCPDP D. 202-B2 Service Provider ID Qualifier If you are unable to populate the NCPDP fields indicated above, contact your software vendor for assistance. NCPDP standards must not be used outside the United States without the express written permission of NCPDP. New Fields Associated NCPDP Fields NCPDP Reject Comment N Y Co-payment Amount X PR Patient Pay Amount. Under the column of “Field Limitations” notations such as “Value “X” may not be used in Telecommunication Field # NCPDP Field Name Value Payer Usage Payer Situation dispensed 57-Discharge Medication- new dispensing of medication and continuation of care due to the patient’s discharge from LTPAC, Clinic, Hospital or similar setting. Ø not included in this document can still be sent but will not be observed by the processor’s business logic. Therefore, all of these segments and fields are required. In addition, this NCPDP Standard contains certain data fields and elements that may be completed by users with the . If applicable, every value/code The NCPDP . If you don't know us, you should. 1Ø1-A1 BIN NUMBER . September 2024 National Council for Prescription Drug Programs 9240 East Raintree Drive Scottsdale, AZ 85260 Phone: (480) 477-1000 Fax: (480) 767-1042 E-mail: ncpdp@ncpdp. Value . Observation Element Group Long Term Care % of exam: 7. 1 updated August 2, 2017 Question Answer Do I have to answer every question in my NCPDP Pharmacy Profile? Yes. ” NCPDP Comment: There are concerns about the timeline for CERT testing occurring during the annual open enrollment period and concerns regarding the short window for CERT testing. GatorCare NCPDP D. While the Quantity Prescribed (460 -ET) field is listed as“Not Used “ within this publication, per CMS-0055-F the Quantity Prescribed field is now REQUIRED for all Schedule II drugs. NCPDP pioneered real-time claims adjudication at the point of service, electronic transmission of prescriptions, point-of-care access to patient medication history, and computerized order entry and results reporting for pharmacy NCPDP Pharmacy Profile Expansion FAQs Page 5 v5. All fields are fixed length. 11_ARC Page 3 of 30 GENERAL INFORMATION Payer Name: Archimedes Date: 01/01/2022 Plan Name/Group Name: All NCPDP ECL Version: Oct 2019 Processor: Elixir NCPDP ECL Emergency Version: Jan 2019 Effective as of: 01/01/2025 NCPDP Telecommunication Standard Version/Release #: D. Field # NCPDP Field Name Value Payer Usage Payer Situation 455-EM PRESCRIPTION/SERVICE REFERENCE NUMBER QUALIFIER of 1 = Rx Billing M Imp Guide: For Transaction Code “B1,” in the Claim Segment, the Prescription/Service Reference Number Qualifier (455-EM) is “1” (Rx Billing). Resulting search information is viewable not only on Field – The NCPDP D. 17 U. How do I view the cross reference of fields used in NCPDP SCRIPT to the model-driven schemas (formerly Appendix B in the PDF version)? What is the DERF Ballots table in Implementation Guide (IG) version D. NCPDP fields 351-NP (Other Payer-Patient Responsibility Amount Qualifier) is present NYRx is committed to making this transition as smooth as possible. The use of these fields will be available under the next HIPAA named version of the NCPDP Telecommunication Standard. proprietary information of third parties. 7 2 DATA FORMATTING The NCPDP Version 1. 56% Task: Demonstrate how specific transaction types can be Section II contains the alphabetical listing of NCPDP data elements contained in the External Code List. Apply for new NCPDP / NPDS numbers; View and update your NCPDP profile information; Report changes in ownership to NCPDP; Did you know CMS requires that all Medicare Part D plans send pharmacy drug event data from claims to CMS. 01. • Obtain membership approval of the DERF Field # NCPDP Field Name Value Payer Usage Payer Situation 1Ø1-A1 BIN NUMBER (see above) M 1Ø2-A2 VERSION/RELEASE NUMBER DØ M 1Ø3-A3 TRANSACTION CODE B1, B3 M 1Ø4-A4 PROCESSOR CONTROL NUMBER See above M Required for All Claims 1Ø9-A9 TRANSACTION COUNT Up to 4 M NOTICE: In addition, this NCPDP Standard contains certain data fields and elements that may be completed by users with the proprietary information of third parties. NCPDP is the approved ANSI format to submit retail pharmacy claims. Insurance Segment Questions Check Claim NCPDP Field Number NCPDP Field Name Value . WG7 Manufacturer Rebates has created Reference Guide documents for the Manufacturer Rebate Standard versions v03. There are required data fields in the NCPDP Provider ID pharmacy record that must be completed before submitting to NCPDP. 111-AM Segment Identification Ø5=COB/Other Payments M 337-4C Coordination of Benefits/Other Payments Count Maximum count of 9 M 338-5C Other Payer Coverage Type M (Other Payer . Claims should be submitted using the processing information shown on the member’s ID card or contained in the member’s profile, if current. §101, NOTICE: In addition, this NCPDP® Standard contains certain data fields and elements that may be completed by users with the proprietary information of third parties. For example, In the Telecommunication Standard v5. 0 (August 2007) and CMS-0055 Final Rule published January 24, 2020. We've been doing this for 40 years. This field should be blank unless the pharmacy is submitting a partial fill claim. org http: www. NCPDP Universal Claim Forms may be purchased from our vendor, CommuniForm LLC. This means you can access field values by a simple name instead of it's 2-character identifier. Imp Guide: For Transaction Code of “B1”, in the Claim Segment, the Prescription/Service NCPDP Universal Claim Forms may be purchased from our vendor, CommuniForm LLC. This page is dedicated to information and resources regarding the NCPDP Version D. 0 Field (550-8F). Additionally, before you can set the credential date, all required documents must be uploaded to your NCPDP profile. The use and distribution of third parties' proprietary information without such third parties' consent, or the execution of a license or other agreement with such third party, could subject dataQ ® OnDemand TM "Do-it-yourself" reporting tool, OnDemand TM allows authorized users to run and save detailed reports selecting from more than 25 criteria (such as dispenser type) and more than 50 fields of information specific to each pharmacy. NCPDP is a dynamic organization, which has innovatively brought together diverse stakeholders to develop solutions to industry needs. to add more detailed field information and to align the document with the task group’s purpose. CMS verifies data on your pharmacy against the NCPDP Online database. 4Ø2-D2 PRESCRIPTION/SERVICE REFERENCE NUMBER M 436-E1 In addition, this NCPDP Standard contains certain data fields and elements that may be completed by users with the proprietary information of thi rd parties. 341-HB Other Payer Amount Paid Count Maximum count of 9 Mandate for updated versions of NCPDP’s SCRIPT and Formulary &Benefit Standards and the newly- named NCPDP RTPB Standard supports interoperability, improves efficiencies, and includes transactions for better informed clinical decision-making at the point of care to improve the healthcare experience for patients and providers; Register to learn from the experts – Field # NCPDP Field Name Value Payer Usage Payer Situation 455-EM Imp Guide: For Transaction Code PRESCRIPTION/SERVICE REFERENCENUMBER QUALIFIER 1 = Rx Billing M of “B1,” in the Claim Segment, the Prescription/Service Reference Number Qualifier (455-EM) is “1” (Rx Billing). without such third parties' consent, or the execution of a license or other agreement with such third party, could NCPDP Field Field Name Mandatory / Situational Comments / Values 301-C1 GROUP ID M Value = ‘CAID’ 302-C2 CARDHOLDER ID M ProviderOne Client ID 306-C6 PATIENT RELATIONSHIP CODE . 0 Pharmacy Encounter 09/10/2020 2 Version 3. Usual and Customary (U&C) [NCPDP Field 426-DQ] 2. Mandate for updated versions of NCPDP’s SCRIPT and Formulary &Benefit Standards and the newly- named NCPDP RTPB Standard supports interoperability, improves efficiencies, and includes transactions for better informed clinical decision-making at the point of care to improve the healthcare experience for patients and providers; Register to learn from NCPDP Resources, Press Releases, White Papers, Documents, Annual Reports. REMINDER: When submitting vaccine claims through the pharmacy benefit, please enter the following data in the appropriate fields. NOTICE: In addition, this NCPDP Standard containscertain data fields and elements that may be completed by users with the proprietary information of third parties. Itemized changes for each new release are tracked the publicationwith . Product Selection Code (408-D8) field values to inform pharmacies of formulary requirements. 60- Long Term Care Same Drug Strength and Dosage From with Multiple Dosing In addition, this NCPDP Standard contains certain data fields and elements that may be completed by users with the . Additional fields for formulary and benefit file cross reference to eliminate use of the formulary field to reference these additional files; It is important to note the NCPDP Telecommunication Standard vD. Therefore, Medicare will now qualify the Part B deductible and/or co-insurance amounts as follows within a brand-new field 351-NP (“Other Payer-Patient Responsibility Amount Qualifier”) created Section II contains the alphabetical listing of NCPDP data elements contained in the External Code List. 4Ø2-D2 PRESCRIPTION/SERVICE REFERENCE NUMBER M 436-E1 Optional fields defined by the NCPDP Telecommunication Implementation Guide Version D. org http: ncpdp. It can be used as a guide of which XML fields are supported in the xsd per NCPDP The field length of 12 will be implemented in DDPS on January 1, 2011 in anticipation of the implementation of the NCPDP D. g. 0 for pharmacy and supplier transactions. Applies to all PDEs submitted January 1, 2011 and after. ** The Group ID is not provided on the member ID card and is not required to process claims. Field# NCPDP Field Name Value Payer Usage Payer Situation This is required for all other BCBS plans when DOB and gender are identical 311-CB PATIENT LAST NAME R Claim Segment Questions Check Claim Billing/Claim Rebill If Situational, Payer Situation This Segment is always sent X This payer does not support partial fills X NCPDP is a dynamic organization, which has innovatively brought together diverse stakeholders to develop solutions to industry needs. Informational. 0 and leverages best practices for various scenarios such as preferred brands for multisource generic situations and the proper use of the Corresponds to “N” format in the NCPDP Standard. §101, et. NCPDP is the problem-solving forum for healthcare - successful and respected throughout the industry. 4Ø2-D2 PRESCRIPTION/SERVICE REFERENCE NUMBER M 436-E1 NCPDP’s External Code List (ECL) entry for Route of Administration (995-E2) points to National Library of Medicine (NLM)’s Value Set Authority Center (VSAC) for the list of values. NCPDP Field Name : Value . 1. This document provides requirements and best practice guidance for implementation when transmitting NCPDP SCRIPT transactions. See pages 45-59 in the NCPDP 5. Refer to the Version D. Section 10 describes the fields within each segment within each transaction. Each retail pharmacy that transmits retail drug claims electronically must use the NCPDP Batch Standard version 1. Under the column of “Field Limitations” notations such as “Value “X” may not be used in Telecommunication NCPDP Implementation Overview - NCPDP has created this document to provide summary information of the transactions requested in the next round of HIPAA. If you have made changes to your pharmacy record, but do not have all the required data fields complete not to worry. Batch-only fields prepended to the NCPDP Resources, Press Releases, White Papers, Documents, Annual Reports. NCPDP understands that the documentation utilized to implement the standard is voluminous and Free Text Fields 6. Field # NCPDP Field Name Value Payer Usage Payer Situation 442-E7 QUANTITY DISPENSED R 4Ø3-D3 FILL NUMBER Ø = Original/First dispense 1-99 = Refill number R 4Ø5-D5 DAYS SUPPLY R 4Ø6-D6 COMPOUND CODE 1 = Not a compound 2 = Compound R 4Ø8-D8 DISPENSE AS NCPDP has become synonymous with problem solving. Because the NCPDP standards maintenance process requires a ballot for any addition, deletion and/or modification to the information contained within a DD, Field # NCPDP Field Name Value Payer Usage Payer Situation 455-EM Imp Guide: For Transaction Code PRESCRIPTION/SERVICE REFERENCENUMBER QUALIFIER 1 = Rx Billing M of “B1,” in the Claim Segment, the Prescription/Service Reference Number Qualifier (455-EM) is “1” (Rx Billing). NOTICE: In addition, certain NCPDP standards contain certain data Use our viewer to make sense of all the header fields in your NCPDP files. M 1Ø2-A2 VERSION/RELEASE NUMBER DØ M 1Ø3-A3 TRANSACTION CODE B1 M Claim Billing 1Ø4-A4 PROCESSOR CONTROL NUMBER RW BLANK FILL 1Ø9-A9 TRANSACTION COUNT Ø1 – Ø4 M filler at the end of the PDE file record for the addition of new unrelated fields. submitted in the NCPDP Telecommunication field Prescription/Service Reference Number (402-D2) field on the claim unless otherwise stated in trading partner agreement. • Obtain membership approval of the DERF Field # NCPDP Field Name Value Payer Usage Payer Situation 455-EM PRESCRIPTION/SERVICE REFERENCE NUMBER QUALIFIER 1 = Rx Billing M Imp Guide: For Transaction Code of “B1,” in the Claim Segment, the Prescription/Service Reference Number Qualifier (455-EM) is “1” (Rx Billing). M . Complete field mapping for all 26 D. 0 batch transaction. Field # NCPDP Field Name . 455-EM PRESCRIPTION/SERVICE REFERENCE NUMBER QUALIFIER 1 = Rx Billing – Transaction is a billing for a prescription or OTC drug product M . Note: do not use “1”, “5,” “6,” “7” or “8” IN THE OCC FIELD – claim will reject. M 2Ø1-B1 SERVICE PROVIDER ID Pharmacy NPI Number M 4Ø1-D1 DATE OF SERVICE CCYYMMDD M 11Ø-AK SOFTWARE VENDOR/CERTIFICATION ID Blank fill M . The NCPDP standard or version formats are listed. These documents provide guidance on a variety of manufacturer rebate scenarios and issues found in the Pharmaceutical industry and will assist in the effective implementation of these versions of the NCPDP Prime Therapeutics Management NCPDP D. required by NCPDP for standard maintenance. Because the NCPDP standards maintenance process requires a ballot for any addition, deletion and/or modification to the information contained within a DD, in the Help Desk Phone Number, NCPDP D. ncpdp@ncpdp. NCPDP Online - enumerator of the NCPDP One concern NCPDP would like addressed is if something that is known at POS changes (if the claim is adjusted and/or the pharmacy price concession changes), will the PDE need to be updated to reflect this change. 05 Page 2 of 79 08/02/2017 NCPDP Profile Part 2 Training Guide Table of Contents The original screens and fields that represent your profile up to February 11, 2017 are displayed on their own tab within what is now called “Part 1”. CMS also uses NCPDP pharmacy information to audit Medicare Part D claims data. 4 X12N/005010X221A1 HEALTH CARE LAIM PAYMENT/ADVICE (835) FILE MATCHING AND REASSOCIATION Claim Segment Segment Identification (111-AM) = “Ø7” Claim Billing/Claim Rebill Field # NCPDP Field Name Value Payer Usage Payer Situation Payer Requirement: (Same as Imp Guide) 344-HF QUANTITY INTENDED TO BE DISPENSED RW Imp Guide: Required for the partial fill or the completion fill of a prescription. org Field # NCPDP Field Name Value Payer Usage Payer Situation 455-EM PRESCRIPTION/SERVICE REFERENCE NUMBER QUALIFIER 1 = Rx Billing M Imp Guide: For Transaction Code of “B1”, in the Claim Segment, the Prescription/Service Reference Number Qualifier (455-EM) is “1” (Rx Billing). Letters are not accepted in the field. This change constitutes a modification to the use of the adopted standard, not a modification to the standard itself. In addition, this NCPDP Standard contains certain data fields and elements that may be completed by users with the proprietary information of third parties. OTHER COVERAGE CODE 2 (FIELD 308-C8)- PATIENT HAS OTHER COVERAGE THIS . S. 0 Pharmacy Help Desk- 888-504-5563, option 2 Claim Billing 477-1000, ncpdp@ncpdp. (460-ET) field for retail pharmacy transactions for Schedule II drugs. We provide the forum and process for diverse healthcare stakeholders to work together for the common good. The use and distribution of third parties' proprietary information without such third parties' consent, or the execution of a license or other agreement Field # NCPDP Field Name Value Payer Usage Payer Situation 101-A1 BIN Number 022659 M NEW! 102-A2 Version/Release Number D0 M 103-A3 Transaction Code B1, B3 M 104-A4 Processor Control Number 6334225 M NEW! 109 -A9 Transaction Count M One transaction for compound claim; Four allowed for B1 or B3. The NCPDP Strategic National Implementation Process (SNIP) has created an important white paper to assist the pharmacy industry in preparing for the implementation of this transaction. (460–ET) field as defined in the NCPDP Telecommunication Standard Version D. xerf olesm athmnw fovxli eejidr yrgdc qhvmp efwk anxs zbpcoip