Work Group 1 Telecommunication develops and maintains standards and guidelines to accommodate the collection, transmission, and processing of electronic pharmacy claim information, i.e. administering and certifying eligibility, prior authorization, and prescribing drug benefits for traditional, managed care, and government programs; billing; payment determination or denial of compensation with explanations, and concurrent drug use review.
Work Group 2 Product Identification deals with issues relating to the identification of drugs and health related products within NCPDP’s stated mission. Identification consists 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.
Work Group 7 Manufacturer and Associated Trading Partner Transaction Standards develops, monitors, and maintains standards for the electronic exchange of data amongst manufacturers and trading partners to facilitate business processes. Additionally, the work group promotes implementation and education of the standards.
Work Group 9 Government Programs, in conjunction with Work Group 1 Telecommunication and other Work Groups, as necessary, guides and advises federal and state pharmacy programs and their agents on NCPDP standards. WG9 also supports data processing initiatives, and provides design alternatives for standards, which support government requirements.
Work Group 10 Professional Pharmacy Services supports the pharmacist’s individual and collaborative planning, delivery, documentation and quality assessment of patient care services through the development and distribution of standards, standards-based templates, and implementation guides. These documents/tools in conjunction with the publication of best practices recommendations encourage patient engagement, foster patient safety and support consistent delivery of patient care services to optimize outcomes.
WG10 strives to support pharmacists in utilizing their unique training and expertise to provide patient care services related to the appropriate use of medications. Patient care services are provided in many different practice settings and include activities such as medication therapy management, clinical reconciliation (medication, allergies and problems), patient immunization management, disease state monitoring, adverse drug event reporting and therapy adherence program management. Pharmacists contribute to improving patients’ health by providing patient care services as authorized by license and allowed under their scope of practice and collaborative practice agreements.
WG9 Government Programs Goals
- Promote NCPDP membership attendance and active participation in work group meetings and task groups.
- Provide a forum for members to discuss new federal and state policies and procedures as they relate to the practice of pharmacy and the NCPDP Standards, which may include but are not limited to:
- Medicare Programs (e.g., Medicare Part A, Part B, Part C, Part D, Hospice, End Stage Renal Disease),
- Medicaid and Children’s Health Insurance Program,
- Medicare-Medicaid Plan (MMP) and other dual eligible programs,
- Federal and state-Funded programs (e.g., State Pharmaceutical Assistance Program, Ryan White/AIDS Drug Assistance Program, 340B),
- Federal and state Health Insurance Marketplaces, and
- Cost and reimbursement basis for government programs (e.g., Actual Acquisition Cost (AAC), Nation Average Drug Acquisition Cost (NADAC), Average Manufacturer Price (AMP), Federal Upper Limit (FUL)).
- Promote and provide support for the use of NCPDP Standards for government programs whether regulated, mandated (i.e., Health Insurance Portability and Accountability Act, Medicare Modernization Act, Affordable Care Act), or through voluntary industry adoption.
- Review and recommend changes to implementation of the standards development process and regulatory process as related to government programs.
- Collaborate with government agencies to develop and maintain Frequently Asked Questions (FAQs) and Best Practices documents to support the implementation of government programs and associated regulations.
- Maintain the Medicaid Subrogation Implementation Guide for Batch Standard and Financial Information Reporting Standard.
- Monitor and track the State Prescription Drug Monitoring Programs.
- Collaborate with Prescription Drug Monitoring programs in identifying and implementing streamlined, innovative and viable electronic solutions.
- Collaborate with the National Medicaid EDI HIPAA Workgroup (NMEH) on issues related to State Medicaid programs.
- Monitor WG9 task groups to ensure they are tracking scope, goals, and deliverables. Disband task groups that have completed their work.
- Support the MC Maintenance and Control Education-Legislation and Regulation Task Group when new legislation is being introduced regarding issues relevant to the work group.
- Collaborate with other NCPDP work groups and Strategic National Implementation Process (SNIP) Committee as needed.
- Review Data Element Request Forms (DERFs) and ballots pertaining to standards within the scope of this work group.
- Analyze, develop and execute Webinar opportunities for WG9 in coordination with Educational Programs Advisors Group.
For a list of acronyms, please see the Acronym Dictionary
WG9 Government Programs Scope
- Work Group 9 Government Programs, in conjunction with Work Group 1 Telecommunication and other Work Groups, as necessary, guides and advises federal and state pharmacy programs and their agents on NCPDP standards. WG9 also supports data processing initiatives, and provides design alternatives for standards, which support government requirements.