Public Review of Proposed NCPDP Standards Information

Public comments are solicited on proposed new standards and proposals to revise, reaffirm or withdraw approval of existing standards simultaneously with the NCPDP ballot period. The NCPDP Public Review of Proposed NCPDP Standards period opens on Wednesday, September 12, 2018 and closes Monday, October 15, 2018. Should you wish to submit an Official Public Comment, the Council must receive your Official Public Comment no later than 5:00 p.m. PDT/ 6:00 p.m. MDT/ 7:00 p.m. CDT/ 8:00 p.m. EDT on Monday, October 15, 2018. All explanatory comments submitted on "Object with Reason" and "Accept with Comments" will be reviewed at the next scheduled Joint Technical Work Group meeting, which will be held November 7 - 9, 2018 in Charlotte, NC. The proposed NCPDP standards packets are:

  1. Proposed NCPDP Standards Packet #WG010079

    WG01 Telecommunication - Proposed NCPDP Standards Packet #WG010079 for enhancements to the Telecommunication Standard Implementation Guide, Audit Standard Implementation Guide, Benefit Integration Standard Implementation Guide, Post Adjudication Standard Implementation Guide, Prior Authorization Transfer Standard Implementation Guide, Retiree Drug Subsidy Standard Implementation Guide and Uniform Healthcare Payer Data Standard Implementation Guide

    This proposed packet contains the following requests from the listed DERFs:

    • DERF 1591 which requested to increase the field length of all dollar fields to accommodate the emergence of drugs that are exceeding the current field limitations for dollar amount.
    • DERF 1597 which requested a new standard, Prescription Drug Monitoring Programs (PDMP) Standard Implementation Guide to provide a consistent format for Prescription Drug Monitoring Programs reporting. New fields added to the PDMP Standard were also added to the Telecommunication Standard for synchronization purposes.
    • DERF 1610 which requested to rename the Patient ID Qualifier Count (618-RR) to Patient ID Count to reflect the naming conventions of a count field and to match the definition of the field. Allow the Patient ID Qualifier Count (618-RR) to be used in the Telecommunication, Subrogation and PDMP Report Standards.
    • DERF 1612 which requested to update the value definition of Measurement Dimension (496-H2), Audit Element Response 1 through 5 (A62 to A66) and Audit Element Type 1 through 5 (A57 to A61) to include additional value description. Modifications to the Audit Implementation Guide were also requested to update the description changes.
    • DERF 1614 which requested to add the preceding zero to values 1-5 and 7-9 of the Patient Pay Component Qualifier (C95-KQ) in order to be consistent with the existing Other Payer Patient Responsibility Amount Qualifier (351-NP) values. Preceding zeros will be added to like values 1-5 and 7-9 for PatientPayComponentQualifier.
    • DERF 1616 which requested to modify the situation for Prescriber DEA Number (D01-KV) in the Telecommunication Standard and the descriptions for reject codes 43, 44, and 46 to accommodate laws that prohibit the use of DEA numbers on a claim.
    • DERF 1617 which requested to add a value to Eligibility Clarification Code (309-C9) for pharmacy providers to submit on claims to indicate to processors when the dispensing is for non-human (Pet Med) use. This value will provide the information needed to process these type claims for Version D.0 of Telecommunication. As a future solution, this DERF requests the addition of a new field.

    Approval of proposed packet #WG010079 would result in the release of the Telecommunication Standard Implementation Guide Version F4, the Post Adjudication Standard Implementation Guide Version 49, the Prior Authorization Transfer Standard Implementation Guide Version 23, the Retiree Drug Subsidy Standard Implementation Guide Version 22, the Uniform Healthcare Payer Data Standard Implementation Guide Version 26, the Audit Standard Implementation Guide Version 34 and the Benefit Integration Standard Implementation Guide Version 14

  2. Proposed NCPDP Standards Packet #WG010080

    WG01 Telecommunication - Proposed NCPDP Standards Packet #WG010080 for enhancements to the Prescription Transfer Standard Implementation Guide

    This proposed packet contains the following requests from the listed DERFs:

    • DERF 1591 which requested to increase the field length of all dollar fields to accommodate the emergence of drugs that are exceeding the current field limitations for dollar amount.
    • DERF 1593 which requested a new field, Automatic Refill Enrolled, used in the transfer of open refill prescription data from pharmacy to pharmacy when Fixed Length structured files are in use.
    • DERF 1610 which requested to rename the Patient ID Qualifier Count (618-RR) to Patient ID Count to reflect the naming conventions of a count field and to match the definition of the field. Allow the Patient ID Qualifier Count (618-RR) to be used in the Telecommunication, Subrogation and PDMP Report Standards.

    Approval of proposed packet #WG010080 would result in the release of the Prescription Transfer Standard Implementation Guide Version 37

  3. Proposed NCPDP Standards Packet #WG090010

    WG09 Government Programs - Proposed NCPDP Standards Packet #WG090010 for enhancements to the Financial Information Reporting Standard Implementation Guide

    This proposed packet contains the following requests from the listed DERFs:

    • DERF 1591 which requested to increase the field length of all dollar fields to accommodate the emergence of drugs that are exceeding the current field limitations for dollar amount.

    Approval of proposed packet #WG090010 would result in the release of the Financial Information Reporting Standard Implementation Guide Version 15

  4. Proposed NCPDP Standards Packet #WG090011

    WG09 Government Programs - Proposed NCPDP Standards Packet #WG090011 for the initial release of the Prescription Drug Monitoring Programs (PDMP) Reporting Standard Implementation Guide

    This proposed packet contains the following requests from the listed DERFs:

    • DERF 1591 which requested to increase the field length of all dollar fields to accommodate the emergence of drugs that are exceeding the current field limitations for dollar amount.
    • DERF 1597 which requested a new standard, Prescription Drug Monitoring Programs (PDMP) Reporting Standard Implementation Guide to provide a consistent format for Prescription Drug Monitoring Programs reporting. New fields added to the PDMP Standard were also added to the Telecommunication Standard for synchronization purposes.
    • DERF 1610 which requested to rename the Patient ID Qualifier Count (618-RR) to Patient ID Count to reflect the naming conventions of a count field and to match the definition of the field. Allow the Patient ID Qualifier Count (618-RR) to be used in the Telecommunication, Subrogation and PDMP Report Standards.
    • DERF 1617 which requested to add a value to Eligibility Clarification Code (309-C9) for pharmacy providers to submit on claims to indicate to processors when the dispensing is for non-human (Pet Med) use. This value will provide the information needed to process these type claims for Version D.0 of Telecommunication. As a future solution, this DERF requests the addition of a new field.

    Approval of proposed packet #WG090011 would result in the release of the Prescription Drug Monitoring Programs (PDMP) Reporting Standard Implementation Guide Version 10

  5. Proposed NCPDP Standards Packet #WG100009

    WG10 Professional Pharmacy Services - Proposed NCPDP Standards Packet #WG100009 for enhancements to Structured and Codified Sig Format Implementation Guide

    This proposed packet contains the following requests from the listed DERFs:

    • DERF 1598 which requested updates to the Structured and Codified Sig Format Implementation Guide to more accurately reflect current industry practice related to the use of structured and codified Sig in electronic prescribing.

    Approval of proposed packet #WG100009 would result in the release of the Structured and Codified Sig Format Implementation Guide Version 2.2

  6. Proposed NCPDP Standards Packet #WG110079

    WG11 ePrescribing & Related Transactions - Proposed NCPDP Standards Packet #WG110079 for enhancements to the Formulary and Benefit Standard Implementation Guide

    This proposed packet contains the following requests from the listed DERFs:

    • DERF 1583 which requested to add a new value to Formulary Status (927-FP) to indicate when the dispensing of a brand product is preferred to the dispensing of a generic product.
    • DERF 1584 which requested clarity to the application and usage of the Limit-Type Coverage Files to the implementation guide.
    • DERF 1591 which requested to increase the field length of all dollar fields to accommodate the emergence of drugs that are exceeding the current field limitations for dollar amount.
    • DERF 1599 which requested the addition of new fields and values and modifications to the implementation guide in order to allow payers to provide additional information about drug alternatives to treat certain indications or conditions.
    • DERF 1600 which requested the addition of Approximate Plan Cost range for products to accommodate the rising adoption of value-based care and Accountable Care Organizations (ACOS).
    • DERF 1623 which requested change the name and definition of Non-Listed Supplies Formulary Status (950-GX) to indicate Medical Supplies.

    Approval of proposed packet #WG110079 would result in the release of the Formulary and Benefit Standard Implementation Guide Version 52

  7. Proposed NCPDP Standards Packet #WG110080

    WG11 ePrescribing & Related Transactions - Proposed NCPDP Standards Packet #WG110080 for enhancements to the SCRIPT Standard Implementation Guide, Specialized Implementation Guide and XML Standard Implementation Guide

    This proposed packet contains the following requests from the listed DERFs:

    • DERF 1564 which requested modifications to the SCRIPT Implementation Guide for the transmission of two occurrences of the diagnosis loop.
    • DERF 1601 which requested to move the element DrugCoverageStatusCode from Medication segments to the BenefitsCoordination segments to allow the formulary status to be payer specific for the medication and the DrugCoverageStatusCode values to align with the current Formulary Status (927-FP).
    • DERF 1603 which requested the addition of the supporting language into the schema annotation regarding support of food allergies.
    • DERF 1604 which requested to include PBMMemberID as an optional field in all BenefitsCoordination structures.
    • DERF 1605 which requested modifications to the schema and SCRIPT Implementation Guide for RxFillIndicator to increase its usefulness within specific messages and to eliminate it from messages where its use may cause confusion related to its purpose.
    • DERF 1606 which requested to remove the PasswordChange Transaction from the XML Standard and reference to it from the SCRIPT and Specialized guides since its use has been superseded by enhanced security authentication processes. Additionally, the sunset of data elements NewPassword and OldPassword is requested.
    • DERF 1607 which requested the removal of references in the schema and implementation guide to data element DeniedNewPrescriptionToFollow which was sunsetted in the SCRIPT Standard version 2014041.
    • DERF 1626 which requested the addition of two new fields to allow the transmission of optional procedure codes.
    • DERF 1627 which requested to clarify the field ReasonCode by modifying its definition.
    • DERF 1629 which requested the addition to the Data Dictionary of the individual identification tags/elements associated to the values for fields PAProcessorIdentification, PatientIdentification, PayerIdentification, PharmacistIdentification, PharmacyIdentification, ProviderIdentification, FacilityIdentification and SupervisorIdentification which were removed from the External Code List based on DERF 001517 approved in May of 2017.
    • DERF 1630 which requested to remove or modify outdated references to the SCRIPT Version 10.6 in the SCRIPT Standard Implementation Guide.
    • DERF 1631 which requested to correct errors in the schema in the MeasurementTiming elements.
    • DERF 1633 which requested to update the language in the SCRIPT Implementation Guide related to Quantity Sufficient guidance to allow more than one message.
    • DERF 1634 which requested a new Patient Identification value for NCPDP Universal Patient Identifier (UPI) to the SCRIPT Standard.

    Approval of proposed packet #WG110080 would result in the release of the SCRIPT Standard Implementation Guide, Specialized Implementation Guide and XML Standard Implementation Guide, all to be known as Version 201x### (Version number to be assigned once Board approval is obtained.)

  8. Proposed NCPDP Standards Packet #WG180001

    WG18 Specialty Pharmacy - Proposed NCPDP Standards Packet #WG180001 for enhancements to the Specialty Pharmacy Data Reporting Standard Implementation Guide

    This proposed packet contains the following requests from the listed DERFs:

    • DERF 1591 which requested to increase the field length of all dollar fields to accommodate the emergence of drugs that are exceeding the current field limitations for dollar amount.

    Approval of proposed packet #WG180001 would result in the release of the Specialty Pharmacy Data Reporting Standard Implementation Guide Version 11

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