NCPDP SNIP Liaison Special Committee

NCPDP Responds to NPRM on HIPAA Transactions

On August 22, 2008 the Notices of Proposed Rule Making (NPRM) for the new versions of the HIPAA transactions and code sets were published in the Final Register. The NCPDP SNIP Committee has completed its review of the Standards NPRM and submitted comments to HHS. Click Here to view the NCPDP Comments.

NCPDP Payer Sheet Template for Telecommunication Version D.0

In anticipation of the move to the Telecommunication Standard Implementation Guide Version D.0 as the next HIPAA-named version for pharmacy claims, the NCPDP SNIP Committee developed guidance to be used in filling out and creating payer sheets based on Version D.0 and above. Payer Sheets may be used in addition to provider manuals or included in provider manuals. Payers may take the request and response template sections within the guidance document, fill out the template per their usage, and send to their trading partners. The guidance also provides instructional sections to assist the payers in completing their payer sheets. Click here for a copy.

White Paper for HIPAA Implementation of NCPDP Standards

In the January 16, 2009 Federal Register, the Department of Health and Human Services listed the Final Rule to Update HIPAA Code Sets and the Final Rule to Update HIPAA Transactions.  Entities should begin their business planning and timelines to support the next transactions and code sets. The NCPDP Strategic National Implementation Process (SNIP) has created an important white paper to assist the industry in preparing for the implementation of transactions. Click here for a copy.

White Paper for HIPAA Implementation of the ICD-10 Code Sets

In the January 16, 2009 Federal Register, the Department of Health and Human Services posted the Final Rule to Update the Medical Data Code Sets Standards to use the ICD-10 code sets. Entities should begin their business planning and create timelines to support the new code sets. The NCPDP Strategic National Implementation Process (SNIP) has created an important white paper to assist the industry in preparing for the implementation of the ICD-10 code sets. Click here for a copy.

Post Adjudication Standard Survey Results

The NCPDP SNIP Committee developed a survey on the NCPDP Post Adjudication Standard Version 2.0 that has been requested for the next round of HIPAA. The survey requested input from Client Groups, Pharmacy Benefit Managers (PBM’s), Payers, Fiscal Agents, and Insurance Programs that currently implement or plan to implement the NCPDP Post Adjudication Standard. The NCPDP survey to gather cost/benefit analysis on this standard closed on January 11, 2008. Survey results will be provided to the Department of Health and Human Services via testimony at the National Committee on Vital and Health Statistics meeting in late January 2008. Click here for a copy of the NCPDP Post Adjudication Standard Version 2.0 Survey results.

Recommendations for Implementation of Telecom Standard Version 5.1

Payer Template--Updated August 2006
In May 2002, the NCPDP SNIP Committee revised the one Payer Template (created in April 2002) and created two Payer Templates - one for Requests and one for Responses. Coordination Of Benefits processing examples were not included in the Request payer sheet template. An update of the Request Payer Sheet was made in August 2006 to provide additional information regarding the two methods of COB processing when the Secondary is being billed.

These documents are templates to be used by processors/third party programs to convey some of the more important features of supporting NCPDP Telecommunication Standard Version 5.1 to their business partners. The documents can be used as a form to be filled in by the processors, to offer guidelines of the information that is important to pharmacy software vendors, switches, implementation units. The documents are meant to supplement the provider manuals that payers build. The documents are meant to supplement (not replace) the provider manuals that processors/payers/health plans build.

These documents can be downloaded, filled in by processors/payers and sent to their vendors, switches, implementation units of the processor/payer's implementation of Telecommunication Standard Version 5.1 (like Payer Plan Sheets are used today).
Payer Sheet Official (MS Word - WinZipped 40.1 KB)

NCPDP Telecommunication Standard vD.0 Implementation Tracking

In preparation of the implementation of the HIPAA mandated Telecommunication Standard vD.0, NCPDP SNIP has created a Sub-Task Group to track the industry readiness. The vD.0 Sub-Task Group needs your assistance to properly track the testing and implementation of NCPDP Telecommunication Standard vD.0. The group has created two forms - one for Plan/Payer and one for Pharmacy/Vendors. Instructions for completing the forms are found in the detailed field definitions on the instruction tab. Completed form or additional questions should be sent to Teresa Strickland at tstrickland@ncpdp.org. Click here for a copy of the blank form. Click here for the Industry Provided Implementation documentation.