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    STANDARDS - STANDARDS INFORMATION


  




Standard Implementation Guide, Data Dictionary and External Code List (ECL)
Logs and Forms
Standards
Standards Compliance Process


Standards

To view an overview of the NCPDP Standards and Implementation Guides, click here.

NCPDP is an ANSI-accredited Standards Development Organization. Currently, these NCPDP standards have been approved as an American National Standard (ANS).

Continuous Maintenance Standards:

  • Audit Transaction v1.0
  • Financial Information v1.2
  • Formulary and Benefit v3.0
  • Manufacturer Rebate v05.01
  • Medicaid Subrogation v3.0
  • Medical Rebate Data Submission v01.00
  • Post Adjudication v3.0
  • Prescription File Transfer v2.0
  • Prior Authorization Transfer v1.0
  • Retiree Drug Subsidy v1.0
  • SCRIPT v2012031
  • Specialized v2012031
  • Telecommunication vD.9
  • Uniform Health Care Payer Data v1.0
Other ANSI Approved Standards:

  • Billing Unit Standard v3.0
For help on the Telecommunication Standard, click here.
For information on the HIPAA Transactions and Code Sets, click here.
For information on the ASC X12N 835 Payment Guidance and Related Documents, click here.

Logs and Forms
Signature Log
Although not a standard, the Signature Log is available to members as guidance. Click Here for the log and instructions.

Best Available Evidence for Low Income Cost Sharing Certification
For Best Available Information (BAE) Form click here.

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What Is The Difference Between The Standard Implementation Guide, Data Dictionary and External Code List (ECL)?
An NCPDP External Code List (ECL) contains values, descriptions, and reject codes for a subset of the data elements supported in the current NCPDP Standards. It is intended to go hand-in-hand with the Data Dictionary and is a subset of that document. (Click here to view the ECL Process Overview)

What Dictionary or External Code List Do I Use?
The Standards Matrix provides a chart of the appropriate NCPDP Data Dictionary and External Code List(s) appropriate for a version of an NCPDP implementation Guide.

An NCPDP Data Dictionary contains the field identifiers, format, values, descriptions, and reject codes for the data elements supported in the various NCPDP Standards. It is intended to go hand-in-hand with a standard and implementation guide.

An NCPDP External Code List (ECL) contains values, descriptions, and reject codes for a subset of the data elements supported in the current NCPDP Standards. It is intended to go hand-in-hand with the Data Dictionary and is a subset of that document. (Click here to view the ECL Process Overview)

Note: Older Standard versions consisted of a Standard document and an Implementation Guide document. The Standard document contained the technical rules, data layout and fomat while the Implementation Guide provided information on the transaction(s), guidance for usage, and examples.Over a period of time these two documents were combined into one Standard Implementation Guide for each standard.

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Standards Compliance Process

NCPDP members have established a process that identifies the steps that should be followed when there is a suspected misapplication of an NCPDP standard(s). Misapplication of a standard might be the incorrect use of a field, format, value, or a stated standard use.

NCPDP Standards are protected by copyright laws; see the second page of each document.

For the 'Steps for Standard Compliance' document, click here. One step in the process is the submission of a 'Request to Review' form to the Standardization Liaison, Lynne Gilbertson (lgilbertson@ncpdp.org), after other pertinent steps have been completed.

For the 'Request to Review' form, click here.

Members can review the suspected misapplications filed and their status. Click here to go to the MC Maintenance and Control page and view the document "State of States Master".

The Standards Compliance Process is not for requesting modifications to the NCPDP Standards or documents. Requests for such modifications should be submitted as DERFs or New Project Requests

The Standardization Co-Chairs are:
Darren Townzen,R.Ph., MBA, Wal-Mart Stores, Inc darren.townzen@wal-mart.com
Margaret Weiker,HP, margaret.weiker@hp.com
Rusty Keith, Surescripts, rusty.keith@surescripts.com
Lee Ann Stember, NCPDP, lstember@ncpdp.org

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CMS Administrative Simplification Enforcement Tool
For filing HIPAA Transactions and Code Set (only) complaints to CMS, please go to http://www.cms.hhs.gov/Enforcement/

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