NCPDP Telecommunication Standard Version F6© & Other Related HIPAA Webinars

Telecommunication Standard Version F6© has changed significantly from Telecommunication Standard Version D.0©. Register to watch this on demand webinar to gain a general understanding of the updated Coordination of Benefits functionality. There are numerous changes to the request and response segments including a plethora of new use cases addressed in the Response Other Payers Segment (renamed from Response Coordination of Benefits/Other Payers Segment in version D.0).

Learning Objectives

• Utilize the three COB billing methods and their key differences.
• Identify the use cases addressed in the Response Other Payers Segment.
• Label the Other Payer information based on benefit classification and relationship type.
• Understand the sunsetting of the discrete patient pay fields.
• Correctly map the primary response to the downstream request.
• Ingest Patient Pay Component fields and how they relate to Coordination of Benefits.
• Recognize how the new regulatory fee fields are used in coordination of benefits claims.
• Learn how to use Reconciliation ID to facilitate claim matching and reversal order.

Speakers:

Leann Lewis, NTC
Member, NCPDP COB F6 Webinar Sub-Task Group
Principal, Product Management, MedImpact Healthcare Systems, Inc.

Melody Cagalingan, M.A., NTC
Leader, NCPDP COB F6 Webinar Sub-Task Group
Leader, Coordination of Benefits Task Group
Senior Advisor, Express Scripts Pharmacy Benefit Services

This session will explore what SNIP is doing to prepare the industry for the challenges as they move from D.0 to F6. The session will cover what SNIP is and what SNIP provides that is different from Task Groups. It will also provide a timeline for implementation of NCPDP Telecommunication Version F6 and share progress on guidance.

After watching this webinar, you will be able to:

• Discuss with staff when changes to pharmacy claims will occur.
• Provide an explanation of transition as it relates to claims processing.
• Communicate upcoming issues that may occur to clerical staff during transition from claim standard to another.
• Prepare and train for the upcoming changes using the timeline presented.

Speaker: Annette Gabel, President, ACAG Consulting

This session will preview the significant changes to the Header segment of the B1 Claim Transaction. The former field BIN Number has been renamed to IIN and has increased in size. In addition, the segment fields have been reorganized.

After watching this webinar, you will be able to:

• Learn the change to the number of transactions per transmission.
• Prepare for claim transaction changes.
• Create clear training documents for staff to use.
• Learn talking points for staff when claims are rejected due to header issues.
• Discuss with staff when changes to pharmacy claims will occur.
• Create training guides for staff on changes to the claim header segment.

Speakers: Kathy Knapp, Project Director, Government Programs, RelayHealth/McKesson and Annette Gabel, President, ACAG Consulting, LLC

This session will inform pharmacies and vendors of the E1 changes required with implementation of NCPDP Telecommunications Version F6. With version F6, much of the data that was returned in the Message field (504-F4) is now returned in designated fields. This session will help prepare for these and other changes introduced in version F6.

After watching this webinar, you will be able to:

• Know where to find information on formatting valid F6 Eligibility Verification Request transactions.
• Identify the three changes required for version F6 Eligibility Verification request submission.
• Understand the purpose of the Response Other Payers Segment in Eligibility Verification Response transactions.
• Know where to locate information that was removed from the Message field on E1 Response transactions.

Speaker: Kathy Knapp, Project Director, Government Programs, RelayHealth/McKesson

This session will review the changes that affect the Medicare Part D Information Transactions. The changes include fields used and associated reject codes (specifically identifying new reject codes), the Medicare Part D Nx Transaction Payer Sheet for F6 and where to find specific resources will also be covered.

After watching this webinar, you will be able to:

• Review the changes that affect the Medicare Part D Information Transactions.
• Identification of new reject codes.
• Review of the F6 Nx Transaction Payer Sheet.
• Resources availability will be provided.

Speakers: Mary A. Perez, Principal Product Manager, MedImpact Healthcare Systems, Inc., and Annette Gabel, President, ACAG Consulting, LLC

This session will provide an overview of important changes to the B1 request transactions that impact almost all claim adjudication scenarios. It will also outline the differences between claim (B1), claim and service (B1) and service request transactions (S1) in alignment with current critical paths within the pharmacy industry. This session will correlate standards changes with example business cases to help support alignment of IT and operational considerations.

After watching this webinar, you will be able to:

• Identify the claim request segment and data element changes between Telecommunication Standard Versions D.0 and F6.
• Understand the business cases that initiated claim request segment and data element changes and/or situation of use changes.
• Evaluate mandatory and optional use data elements to meet regulatory and business objectives.
• Identify the differences between the B1 claim billing and S1 service billing request transactions.

Speakers: Jennifer Ausbrook, Senior Manager, Network Standards, CVS Health, and Sharon Gruttadauria, Director Strategic Product Management, CVS Health

This session will provide an overview of the important changes to the B1 claim response transaction that impact almost all claim adjudication scenarios. This session will also review example business cases for optional claim response fields to facilitate interoperability with subsequent electronic communications between payer, pharmacy and prescriber systems.

After watching this webinar, you will be able to:

• Identify the claim response segment and data element changes between Telecommunication Standard Versions D.0 and F6.
• Understand the transition from existing Additional Message Information Qualifiers to new distinct response data elements.
• Understand the business cases that initiated claim response segment and data element changes and/or situation of use changes.
• Evaluate mandatory and optional use data elements to meet regulatory and business objectives.
• Understand importance of precise claim response detail that triggers subsequent electronic communications.

Speakers: Jennifer Ausbrook, Senior Manager, Network Standards, CVS Health; and Tara DeCosta, MBA, Sr. Director, Adjudication BPO, Express Scripts; and Sharon Gruttadauria, Director Strategic Product Management, CVS Health

Over the 10+ years since Telecommunication Standard Version D.0 was implemented, the pharmacy industry experienced tremendous growth in the coordination of benefits realm. Because of this growth, Telecommunication Standard Version F6 has changed significantly from Telecommunication Standard Version D.0. There are numerous changes to the request and response segments including a plethora of new use cases addressed in the Response Other Payers Segment (renamed from Response Coordination of Benefits/Other Payers Segment in version D.0).

After watching this webinar, you will be able to:

• Gain a general understanding of Coordination of Benefits functionality available through the use of Telecommunication Standard Version F6.
• Identify the use cases addressed in the Response Other Payers Segment.
• Understand the sunsetting of the discrete patient pay fields.
• Pay Component fields and how it relates to Coordination of Benefits.
• Recognize how the new tax fields are used in coordination of benefits claims.
• Learn how to use Reconciliation ID to facilitate claim matching and reversal order.

Speakers: Louise Gustafson, MBA, Principal Product Manager, MedImpact Healthcare Systems, Inc. and Joann M. Landry, COB Manager, CVS Health

Under the NCPDP Telecommunication Standard Version D.0 there are challenges in matching reversal requests to original claim billing requests, as well as other reversal processing issues reported by both processors and providers. As such, NCPDP provided ‘best practice’ recommendations for Telecommunication Standard Version D.0 Claim Reversal processing. With the future move to F6, some aspects of those recommendations are changing, and a new field will be introduced to further ease that process.

After watching this webinar, you will be able to:

• Apply best practices for Reversals.
• Define the Reconciliation ID and its use in reversals.
• Distinguish key fields required for a Reversal Request.
• Describe differences between D.0 and F6 for Reversals.
• Identify the most appropriate Reject Codes to use for rejected Reversals.

Speaker: Kelley Vaughan, AVP, Product, Abarca Health

This session will describe how the Batch Standard Implementation Guide has changed from Version 1.2 to Version 15 and the replacement of the Batch Standard Medicaid Subrogation Implementation Guide with the Batch Standard Subrogation Implementation Guide for use by all payer types.

The NCPDP Batch Standard Implementation Guide is intended to provide a file submission standard which supports prescription claim transactions, services, and reporting between industry participants. The NCPDP Batch Standard allows trading partners to exchange transactions when real-time processing is not available or enabled. The Batch Standard Subrogation Implementation Guide provides a mechanism for payer-to-payer exchange of pharmacy claim information for subrogation or “Pay and Chase” scenarios.

After watching this webinar, you will be able to:

• Understand the differences between the Batch Standard Version 1.2 and Version 15.
• Understand what subrogation is and why it may be needed for pharmacy claims.
• Learn how the Batch Standard Subrogation Implementation Guide should be used for Medicaid Subrogation.
• Recognize how the Batch Standard Subrogation Implementation Guide can be used in other payer-to-payer subrogation scenarios.

Speaker: Louise Gustafson, MBA, Principal Product Manager, MedImpact Healthcare Systems, Inc.

In this session, you will learn of available resources to help you understand and implement the next HIPAA named NCPDP pharmacy standards. We will explore the members-only Standards Lookup Tools for accessing the Data Dictionary, External Code List, standards implementation guides and matrices from the MyNCPDP® website. Changes in the payer sheet template and transition guidance from Telecommunication Standard Version D.0 to F6, being drafted by the Strategic National Implementation Process (SNIP) Committee, will also be discussed.

Speaker: Leslie Carr, CPhT, Standards Specialist, Standards Development, NCPDP, staff liaison for WG1 Telecommunication and WG45 External Standards Assessment and Implementation Guidance

Join us for the webinar NCPDP Pharmacy Standards – HIPAA Updates to gain a comprehensive overview of important changes made to Telecommunication Version F6 and the Batch and Subrogation Standards. By attending this session, you will learn about critical revisions in Telecommunication Version F6 that include modifications to the DUR/PPS Response Segment, updates to the Request Patient Segment and Response Patient Segment, a new Response Provider Segment, new Response Claim segment field, and more. Plus, benefit from knowing the new Batch Standard updates like the Transaction Reference Number length increase, clarified use of multiple entity types, example modifications, and FAQs. And deepen your understanding of the Subrogation Implementation Guide changes that will help meet compliance requirements, reduce manual processes, support a new uniform approach to claims, achieve payment accuracy and support cost containment.

NCPDP is continuously reviewing and updating the three standards to improve workflows and reduce errors in data collection. Hundreds of requested changes were incorporated into these standards that will be used by payers and processors to support pharmacy claims processing, eligibility verification, predetermination of benefits, prior authorization and information reporting. The goal is to optimize communication between payers, providers, and patients to ensure patient safety, better medication adherence and improved access to care.

Speaker: Margaret Weiker, Vice President, Standards Development, NCPDP

In March of 2021, the NCPDP Foundation funded an effort to migrate the NCPDP Telecommunication standard to a syntax consistent with current technology. Working closely with NCPDP staff, the WG1 Telecommunication Agility Next Generation (TANG) Task Group members and members of WG1 Telecommunication, JSON was selected. The outcome of this project is a JSON representation of the Telecommunication Standard Version F6 content in a way that is supported by current tooling and skill sets. Needs identified by NCPDP members, such as extensibility have been added. In addition, for alternative connectivity protocols and enhanced security options are possible.

Watch this on demand video to learn key areas of the project: stakeholder engagement, analysis of options available, the development and testing approach, and finally, information about the model itself.

After this educational session, attendees will be able to:

• State why the project to create a new format for the National Council for Prescription Drug Program's (NCPDP) Telecommunication (Telecom) Standard was undertaken
• Identify the data notation format used in the new Telecom Standard.
• Identify two design goals of the new Telecom Standard.
• Identify two major differences between the existing Telecom Standard and the new Telecom Standard.
• Name a feature of the new Telecom Standard that enables implementers to extend the information that can be conveyed.

Speakers: Frank McKinney, Senior Consultant, Point of Care Partners