Public Documents
This section of our website is intended to share various NCPDP documents which are of interest to the pharmacy services sector of the health care industry. Subsections include information on:
Prescription Monitoring Programs
Tamper-Resistant Prescription Pads
Drug Pedigree, Messaging and Tracking: Glossary of Terms
Long Term Care Rebate Reporting Guidance
Pharmacy Identification Card
Rebate Reference Guide
X12N 835 Payment Template
Payer Audit Reporting using X12N 835 v4010
HIPAA Transactions and Code Sets Current
Version D Editorial - May 2010
HIPAA Transactions and Code Sets Historical
Version 5 Editorial - February 2010
NCPDP Strategic National Implementation Process
Information about NCPDP Task Groups
NCPDP Work Group 16 Guidance for the Property & Casualty and Workers' Compensation Industry
State of the States Public Documents
Prescription Monitoring Programs
Prescription Drug Monitoring Programs are a major tool being used by states to address prescription drug abuse, addiction and diversion. Such programs
are commonly referred to as PMPs. A PMP is a statewide electronic database which collects designated data on controlled substances dispensed in the state. The PMP is housed by a specified statewide regulatory, administrative or law enforcement agency. The housing agency distributes data from the database to individuals who are authorized under state law to receive the information for purposes of their profession.
WG9 Government Programs has created a document which provides information for State PMPs. Information includes program name, schedules monitored, format, batch/on-line, submission methods, reporting frequency, processor, overseeing agency and contact information.
Click here for a copy of this document.
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Tamper-Resistant Prescription Pads
On June 26, 2008, the National Council for Prescription Drug Programs (NCPDP) held a second industry forum in an effort to review the implementation of the first phase of the CMS tamper-resistant regulations and to discuss next steps necessary to ensure a smooth transition into the second phase of implementation on October 1. As a result of this meeting, industry standards for copy, erasure/modification, and counterfeit resistance have been clarified. Also, CMS had previously stated that prescriptions printed from EMRs or ePrescribing applications would likely need special copy resistant paper to be in compliance as of October 1, 2008. CMS is now clarifying that guidance, based on its awareness of improved printing capabilities, and is now stating that while special paper may be used to achieve copy resistance, it is not a requirement. EMR or ePrescribing generated prescriptions may be printed on plain paper and be fully compliant with all three categories of the tamper-resistant regulations provided they contain at least one feature from each of the three categories.
The attached letter recommends best practices developed by the industry forum and is strongly suggested for adoption in order to meet the tamper-resistant requirements.
In addition to this guidance, we have created a template letter for you to use when communicating this information to your prescriber community. You are encouraged to modify this letter with your state specific requirements.
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Drug Pedigree, Messaging and Tracking: Glossary of Terms
WG17 Pharmaceutical Pedigree and Traceability has created a glossary of commonly occurring acronyms and terms related to drug pedigree and supply chain track and trace. The intent of this document is to facilitate industry understanding of the issues and regulations related to product authentication, serialization and identification in the supply chain, and tracking. Click here for a copy of this document.
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Long Term Care Rebate Reporting Guidance
WG14 Long Term Care Pharmacy Rebate Task Group, in collaboration with Centers for Medicare and Medicaid (CMS), developed the "Long-Term Care (LTC) Rebate Reporting Guide for Medicare Part D". This document provides guidance for LTC pharmacies in reporting rebates to Part D sponsors or Pharmacy Benefit Managers representing Part D sponsors, and identifies inherent limitations in both the scope and the use of the data.
In February, the "Long-Term Care (LTC) Rebate Reporting Guide for Medicare Part D" was modified to reflect the 2008 CMS requirement for reporting drugs at the NDC level. Click here to view the updated document.
In addition, Members of WG14 participated in development of an industry-wide consolidator for pharmacy reported rebates. If you are a PBM or Part D Plan and would like to explore using this solution, as opposed to building/maintaining your own, please contact Linda Campbell at lcampbell@smithpremier.com or visit the Smith Premier Rebate Reporting web page at www.premierltcsubmit.com.
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Pharmacy Identification Card
NCPDP Pharmacy ID Card Fact Sheet
The following document relates to the current NCPDP Health Care
Identification Card Pharmacy ID Card Implementation Guide. The purpose
of the fact sheet is to provide details about the NCPDP format and may be
distributed to members and non-members. If you have any questions about the
fact sheet, please contact
Kittye Krempin at the Council office at
(480)477-1000 ext. 134.
NCPDP Pharmacy ID Card Fact Sheet
Qualifier Code Values for Use in Discretionary Data Loop
This document is Appendix H—Health Care ID Card Values of the NCPDP External Code List. Health Care ID Card Qualifier Codes enable card issuers to include information such as effective dates of benefit coverage, cardholder address, dependent names and person codes, gender codes, dates of birth, etc. and support full implementation of machine-readable information on Healthcare ID Cards. Click here for a copy of this document.
Mapping of the Pharmacy ID Card to the ASC X12N 270/271
This 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.
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Rebate Reference Guide
WG7 Manufacturer Rebates has created Reference Guide documents for the Manufacturer Rebate Standard versions v03.02 and v04.01. 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 Manufacturer Rebate Utilization, Plan, Formulary, and Reconciliation Flat File Standard. Click here for a copy of this document.
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X12N 835 Payment Template
WG45 External Standards Assessment, Harmonization and Implementation Guidance revision of the ASC X12N 835 (004010X091A1) Pharmacy Remittance Advice Template was completed November 2007. The ASC X12N 835 (004010X091A1) Pharmacy Remittance Advice Template must be used in conjunction with the ASC X12N 835 V4010/4010A1 Implementation Guide and does not supercede the HIPAA Implementation Guide. The template is meant to supplement the provider manuals that payers build. Payers can use this template to convey the important features of supporting the ASC X12N 835 Implementation Guide to their business partners
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Payer Audit Reporting using X12N 835 v4010
WG45 External Standards Assessment, Harmonization and Implementation Guidance revision of the Payer Audit Reporting Transaction was completed November 2008. This document provides guidance to the pharmacy sector of the health care industry for reporting the outcome of a payer initiated post payment audit and adjustment of pharmacy claims using the ASC X12N 835 004010X091A1 Health Care Claim Payment/Advice.
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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 - February 2010
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Version D 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 D. 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, and Medicaid Subrogation Implementation Guide, as appropriate
. Please continue to review this link as the document is updated as needed. Version D Editorial - May 2010
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NCPDP Work Group 16 Guidance for the Property & Casualty and Workers' Compensation Industry
NCPDP Property & Casualty and Workers' Compensation Work Group 16 (WG16) has created this guidance document as a resource to the industry on the use and application of NCPDP standards to meet the business requirements of the Property & Casualty and Workers’ Compensation Insurance environment. Currently the document provides the following guidance “Brand/Generic Selection and Invoicing when both the Brand and Generic NDC and Cost Must Be Present”. The document is designed to contain two sets of information: Frequently Asked Questions (FAQ) and Detailed Guidance. Periodic additions and modifications are anticipated as new issues and business needs are brought forward. Questions and issues needing industry guidance should be submitted to the WG16 Co-Chairs or the assigned NCPDP staff liaison.
To view the document click here.
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State of the States Public Document
WG9 Government Programs tracks State Medicaid agencies’ use of the Telecommunication Standard. Click here to see the State of the States Public Document.
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