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HIPAA Transactions and Code Sets Historical
NCPDP Payer Sheet Template for Telecommunication Version 5.1
HIT White Paper
Supply Billing
HHS HIPAA Information
Final Rule Information
Version 5 Editorial - November 2010
NCPDP Payer Sheet Template for Telecommunication Version 5.1
The NCPDP SNIP Committee developed guidance to be used in filling out and creating payer sheets based on Version 5.1. 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.
HIT White Paper
September, 2004 WG9 - Government Programs completed a white paper that was jointly developed with NMEH. The purpose of this
white paper is to educate CMS and others on the billing of drugs for HIT. CMS had provided, through the FAQ process,
guidance that the X12 837 was to be used by HIT providers for the billing of HIT drugs rather than the NCPDP 5.1
Telecommunication/1.1 Batch standards. A copy of this paper was also sent to NCVHS and WEDi' Business Issues Group. For a
copy of this paper and associated appendices,
click here (5.9 meg).
For a copy of the response from Secretary Thompson, click here.
Supply Billing
June 2004 The National Committee on Vital and Health Statistics, Subcommittee on Standards and Security has posted their
recommendation letter to Health and Human Services (HHS) on the billing of supplies in retail pharmacy. The letter can be
found on the NCVHS website
http://www.ncvhs.hhs.gov/
under "Hot Topics", "Letters to Secretary Thompson". The letter recommends the continued use of NCPDP standards for billing
of supplies that are consumed or used during, or as a consequence of the administration of drug therapy or commonly
dispensed via a retail pharmacy channel. They also noted that when supplies are billed by the dispensing pharmacy, the NDC
should be used when an NDC is available. If no NDC, any codes available in the standard should be used, such as the UPC,
HRI, and HCPCS. They also recommended that HHS investigate rulemaking if necessary, as well as possible overlaps in the use
of the NCPDP and X12 standards.
It is anticipated that updates will be given as a HHS investigates rulemaking and other actions. Per previous CMS FAQ guidance, contingency plans should be in place to support the current practices.
March 2004 Industry representatives provided testimony to the National Committee on Vital and Health Statistics (NCVHS) on
the Designated Standards Maintenance Organization Change Request 492, which was for the billing of supplies.
More Information
Testimony
September 2003 Industry representatives met on September 4, 2003 with Centers for Medicare and Medicaid (CMS)
representatives. The topic was to discuss that retail pharmacy continue to be able to use NCPDP standards to bill supplies
rather than the ASC X12 837 batch standard that CMS currently believes retail pharmacy must use after the October 16, 2003,
HIPAA transaction implementation deadline. More Information
Important Points:
- CMS said that they would open up the billing of supplies issue for public comment by publishing a proposed rule next spring.
- CMS said that retail pharmacy could continue to use NCPDP standards to bill supplies until CMS published a final ruling on this issue, but only if pharmacies and their business partner payors/PBMs and processors developed a contingency plan that described why continuing to use the NCPDP standards was in their best interest.
- CMS also will require that these business partners must be able to demonstrate good faith efforts in trying to comply with HIPAA standards... for example, communications that try to convince CMS to allow retail pharmacy to use NCPDP standards to bill supplies.
- CMS said they would publish a statement in the form of a Frequently Asked Question (FAQ) the week of September 8, 2003 that will clarify the guidance CMS published on July 24, 2003 about the requirements of both the contingency plan and the good faith efforts.
- CMS plans to use the FAQ and the July 24 guidance in meetings with state Medicaid agencies so that Medicaid can continue to accept NCPDP standard supply claims.
August 2003 During the August work group meetings, NCPDP members decided to take further action of their governmental
representatives to request guidance to use the NCPDP standards on the billing of supplies for the Transactions and Code
Sets rule under HIPAA. The following documentation has been created. Please begin with the "read me" document. Information.
Final supplies packet.
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HHS HIPAA Information
The Department of Health and Human Services has a website for HIPAA information. This site has program memorandums,
outreach documents, frequently asked questions, and schedules for educational sessions.
Please see
http://www.cms.hhs.gov/HIPAAGenInfo/.
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Final Rule Information
NCPDP Standards Named in HIPAA Transactions and Code Sets Regulations
August 17, 2000 The Department of Health and Human Services Administrative Simplification
final rule on Transactions and Code Sets was published in the Federal Register.
See http://www.cms.hhs.gov/HIPAAGenInfo/ The rule adopts NCPDP Telecommunication Standard
Version 5.1 and Batch Standard Version 1.0 for pharmacy claims. Other transactions used
by the pharmacy industry are also named.
May 31, 2002 corrections to this Final Rule were published for public comment
http://www.cms.hhs.gov/HIPAAGenInfo/. Corrections include naming NCPDP Batch Standard
Version 1.1, NDC versus HCPCS code usage, other pharmacy transaction corrections, and
corrections to the ASC X12N HIPAA implementation guides.
February 20, 2003 The Final Rule for transactions and code sets were published
http://www.cms.hhs.gov/hipaa/hipaa2/default.asp
Changes include naming NCPDP Batch Standard Version 1.1, NDC versus HCPCS code usage, other pharmacy transaction
corrections, and corrections to the ASC X12N HIPAA implementation guides.
Final Rule Information for Pharmacy
The following document is provided by NCPDP as a service, but readers should consult a copy of the rules and
corrections and determine their business needs accordingly. This document will be updated, as new information is
known. Last Updated: 10/23/2007.
Final Rule Information on Electronic
Transactions As It Relates to the Pharmacy Industry
Information on "Implementation of the Telecommunication or Batch Standard" for HIPAA.
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Version 5 Editorial
Frequently Asked Questions, Important Editorial Changes
This document provides a consolidated reference point for questions that have been posed
based on the review and implementation of the NCPDP Telecommunication Standard,
Implementation Guide, and Data Dictionary for Version 5. This document also addresses
editorial changes made to these documents. Since the HIPAA-named Standards documents are
"frozen" from changes, this document provides helpful FAQs, typographical changes and
corrections, and further guidelines for implementation. This document is very important
to implementers of the Telecommunication and Batch Standards. Please continue to review
this link as the document is updated as needed. Version 5 Editorial - November 2010
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