RESOURCES

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Documents | Guides and Templates

NCPDP Quantity Prescribed (460-ET) Implementation Timeline Guidance

NCPDP Quantity Prescribed (460-ET) Implementation Timeline Guidance

This paper offers guidance to the pharmacy industry in preparing for the implementation of CMS-0055-F, which requires the Quantity Prescribed (460-ET) field for all Schedule II drugs.

Documents | Guides and Templates

Quantity Prescribed (460-ET) Guidance

Quantity Prescribed (460-ET) Guidance

The final rule CMS-0055-F published on January 24, 2020, adopts a modification of the requirements for the use of the Telecommunication Standard Implementation Guide, Version D, Release 0 (Version D.0), August 2007, National Council for Prescription Drug Programs, by requiring covered entities to use the Quantity Prescribed (460-ET) field for retail pharmacy transactions for Schedule II drugs. This change constitutes a modification to the use of the adopted standard, not a modification to the standard itself. Click for more details.

Webinars

From Months to Minutes – Advancements in Standards, Innovations Increasing Speed to Therapy in the Most Challenging Prescribing Workflows

From Months to Minutes – Advancements in Standards, Innovations Increasing Speed to Therapy in the Most Challenging Prescribing Workflows

The presentation will describe how today’s standards and innovations are getting therapies to patients not in months, but in minutes. Efficiencies occurring in the trenches of care delivery will be discussed along with lessons learned about filling workflow gaps that still exist today.

Informational

Medicaid Program; Establishing Minimum Standards in Medicaid State Drug Utilization Review (DUR) and Supporting Value-Based Purchasing (VBP) for Drugs Covered in Medicaid, Revising Medicaid Drug Rebate and Third Party Liability (TPL) Requirements

Medicaid Program; Establishing Minimum Standards in Medicaid State Drug Utilization Review (DUR) and Supporting Value-Based Purchasing (VBP) for Drugs Covered in Medicaid, Revising Medicaid Drug Rebate and Third Party Liability (TPL) Requirements

CMS published a proposed rule “Medicaid Program; Establishing Minimum Standards in Medicaid State Drug Utilization Review (DUR) and Supporting Value-Based Purchasing (VBP) for Drugs Covered in Medicaid, Revising Medicaid Drug Rebate and Third Party Liability (TPL) Requirements.” The proposed rule seeks to promote value-based payments for prescription drugs and assess pharmacy benefit manager (PBM) accumulator programs and their impact on calculating average manufacturer price (AMP) and implement standards that would enhance a states’ ability to identify or limit inappropriate prescribing of opioids if a beneficiary is already receiving medication assisted treatment for substance use disorder (SUD).

Documents | Guides and Templates

HIPAA Information 

HIPAA Information 

This section contains information for the public about the Health Insurance Portability and Accountability Act of 1996 as it relates to the pharmacy industry.

Presentations

NCPDP 2020 State of the Association: Strategic Initiatives

NCPDP 2020 State of the Association: Strategic Initiatives

In this video, NCPDP President & CEO, Lee Ann Stember, gives an update on the 2019-2020 Strategic Initiatives: the Universal Patient Identifier, Powered by Experian Health UIM & NCPDP Standards™; the NCPDP Real-Time Prescription Benefit Standard; Specialty Pharmacy; and the NCPDP Standards-based Facilitators Model for PDMP, An Interoperable Framework for Patient Safety.

News

Get NSC-II Certified from the Convenience of Your Home Office – Here’s What’s in it For You!

Get NSC-II Certified from the Convenience of Your Home Office – Here’s What’s in it For You!

There’s no better time than now to get NSC-II certified. The NCPDP NSC-II SCRIPT Certification is a must have for every healthcare professional who interacts with ePrescribing – whether you design and implement EHR systems; forecast and prepare for organizational risks; define pharmacy policy; develop requirements; program pharmacy systems; define product specifications or develop and deliver training for project teams and end users.

Webinars

The Future of Pharmacy

The Future of Pharmacy

This presentation will touch on a broad range of topics including pharmacogenomics, 3D drug printing, tablet recognition, personal medication assistant, drone delivery, telepharmacy, medical marijuana, prescribing authority, reimbursement of services, tech-check-tech (TCT) and technician immunizations.

News

NCPDP Foundation - Donate A Silent Auction Item

NCPDP Foundation - Donate A Silent Auction Item

There is still time to donate an item for the NCPDP Foundation’s “Christmas in July” Silent Auction, July 15-17. The deadline for receipt of items by the Foundation is Friday, June 26. This will allow time to present the item on the mobile bidding application for potential bidders to preview and plan their bidding. Gift cards are always popular as well as items that can be shipped easily and cost-effectively. To donate an item, please contact Debra Chavez at dchavez@ncpdp.org or 480-477-1000, Ext. 122. She will get all the information she needs from you and provide details on where to send the item. Item donations are tax deductible and the NCPDP EIN is 46-2161880. The Silent Auction is a significant fundraiser for the Foundation and important to its ability to continue funding research and pilots that prove the value of NCPDP standards and promote widespread use of them to make accessible healthcare better and safer.

White Papers

Controlled Substance - Quantity Prescribed White Paper

Controlled Substance - Quantity Prescribed White Paper

The purpose of this white paper is to provide information and guidance on the use of the Quantity Prescribed (460-ET) field to address the Schedule II controlled substances (CII’s) billing issues identified in the September 2012 OIG report and to address issues with state requirements related to CII’s for dispensing of medication in increments less than the amount prescribed.

Documents | Guides and Templates

SCRIPT Implementation Recommendations Document Version 1.53

SCRIPT Implementation Recommendations Document Version 1.53

This document provides requirements and best practice guidance for implementation when transmitting NCPDP SCRIPT transactions. This document also contains editorial corrections, clarifications to the NCPDP SCRIPT Implementation Guide documents.

Documents

NCPDP.org & Standards New Websites Quick Start Guide

NCPDP.org & Standards New Websites Quick Start Guide

Overview of what's new and navigation for the new ncpdp.org and standards.ncpdp.org websites.

Presentations

MyNCPDP Navigation Overview Video

MyNCPDP Navigation Overview Video

45 second video of the new Member Portal MyNCPDP.org navigation

Presentations

Presentations

Presentations

NCPDP 2020 State of the Association - NCPDP Website and Member Portal Review

NCPDP 2020 State of the Association - NCPDP Website and Member Portal Review

The first installment of our 2020 State of the Association IMPACT Report video series. President & CEO, Lee Ann Stember provides you with a sneak peek at the new look-and-feel of our updated website and our MyNCPDP Member Portal.

Documents

NCPDP Certification Exam Policy

NCPDP Certification Exam Policy

The Certification Exam Policy is set by NCPDP® and as such, NCPDP reserves the right to change this policy without notice. NCPDP offers computer-based testing as its testing method. You have the option to take your exam during one of NCPDP’s Quarterly Work Group Meetings, at a Kryterion Testing Center location, or you may take the exam as an Online Proctored test from your own computer with Internet access and an external webcam meeting minimum requirements. You can schedule any of the above testing delivery options at a time convenient to you.

Documents

2020-21 Standardization and Work Group  Co-Chairs

2020-21 Standardization and Work Group  Co-Chairs

Listing of the 2020-21 Work Group Co-Chairs and Standardization Committee

Documents

2020-2021 Work Group Co-Chairs

2020-2021 Work Group Co-Chairs

Contact listing of 2020-21 Work Group Co-Chairs

Documents | Guides and Templates

Opioid Guidance

Opioid Guidance

NCPDP Recommendations for Standardized Communications to Address the Opioid Epidemic provides a short summary of issues and available guidance for implementation of opioid policies. Many states have enacted legislation that imposes some type of prescribing limits (including days supply and morphine milligram equivalency), guidance or requirements on prescriptions in order to combat the opioid crisis. Inconsistency in the implementation of these policies has presented challenges throughout the pharmacy supply chain for providing patients access to needed medication in a timely manner.

Press Releases

NCPDP Issues COVID-19 Guidance For Pharmacy-Led Testing For Immediate Industry Implementation

NCPDP Issues COVID-19 Guidance For Pharmacy-Led Testing For Immediate Industry Implementation

Standards-Based Information and Protocols Support Recent Authorization for Pharmacists to Order, Administer FDA Authorized COVID-19 Tests

Documents | Informational

Industry Acronym Dictionary

Industry Acronym Dictionary

If you would like to suggest an acronym, please send an email to NCPDP@ncpdp.org with subject line "Suggested Acronym".

Documents | Guides and Templates | Informational

NCPDP Processor ID (BIN)

NCPDP Processor ID (BIN)

The NCPDP Processor ID Number (BIN) is a six-digit number that health plans can use to process electronic pharmacy claims if they do not use pharmacy benefit cards with a magnetic stripe. Plans that use cards with a magnetic stripe should use the recommended American National Standards Institute (ANSI) Issue Identifier Number (IIN) for processing electronic pharmacy claims. ANSI issues IIN numbers. NCPDP issues the Processor ID Number (BIN). It is important to understand the difference between the IIN and NCPDP Processor ID Number (BIN) before applying for a Processor ID Number (BIN).

Documents | Guides and Templates

Emergency Preparedness

Emergency Preparedness

This page provides guidance to the pharmacy industry for resources available during a declared emergency. The intended audience is healthcare industry providers who would need resource information for eligibility and claims processing affecting displaced individuals.

Documents | Guides and Templates

NCPDP Emergency Preparedness Information v1.7

NCPDP Emergency Preparedness Information v1.7

This document provides resource information for the pharmacy industry for a declared emergency

Documents | Guides and Templates

Meaningful Use Resources

Meaningful Use Resources

Meaningful Use - NCPDP and Industry Resources

Documents

NCPDP Standards Matrix

NCPDP Standards Matrix

The following is a high-level overview of the latest version/release and/or the most commonly used of those standards and implementation guides, as well as NCPDP’s Data Dictionary and External Code List. Additionally, this document provides version/release/publication reference charts for approved and draft NCPDP standards/implementation guides.

Documents | Guides and Templates

HL7 CDA® R2 Implementation Guide:  Medication Therapy Management (MTM) Templates

HL7 CDA® R2 Implementation Guide:  Medication Therapy Management (MTM) Templates

Two guides and templates which support the documentation and communication needs of the expanding Medication Therapy Management (MTM) services arena and the CMS Medicare Part D reporting and patient information requirements for MTM. They are to be used for the exchange of medication related information including assessment results, recommendations for modifications to medication regimens, recommendations for other services (e.g., dietary or laboratory) and the results of interventions between/among providers, payers, pharmacy benefit managers (PBMs) and patients.

Documents | Guides and Templates

Prescription Drug Monitoring Programs (PDMP) Resources

Prescription Drug Monitoring Programs (PDMP) Resources

Nearly all states have enacted laws to establish PDMPs, electronic databases to collect data on controlled substances dispensed or prescribed within their jurisdictions. However, the absence of business rules governing or allowing sharing of information from state to state and across pharmacies, lack of interoperability among the operational PDMPs, and variation in the timeliness of data reporting make it difficult for states and law enforcement to prevent misuse, abuse and fraud.

Documents | Guides and Templates | White Papers

NCPDP Standards-based Facilitated Model for PDMP: Phase 1

NCPDP Standards-based Facilitated Model for PDMP: Phase 1

In an effort to reduce patient prescription drug overdoses and drug abuse, this white paper recommends Phase 1 solutions to assist authorized healthcare providers, including prescribers and pharmacists, in making more informed clinical decisions prior to writing and dispensing medications.

Documents | Guides and Templates

SPAP ADAP Resources

SPAP ADAP Resources

NCPDP, CMS, and the CMS Transaction Facilitator are continually enhancing processes to identify claims for TrOOP eligible State Pharmaceutical Assistance Programs (SPAPs) and AIDS Drug Assistance Programs (ADAPs).  Their goals are to help increase the likelihood that SPAP and ADAP claims are appropriately applied to the member’s TrOOP and that the appropriate entity is refunded or invoiced in the event of a copay/coinsurance adjustment.

Guides and Templates | Informational

Specialty Pharmacy Resources

Specialty Pharmacy Resources

If you would like to participate, you can work collaboratively with colleagues and competitors alike to advance health information technology solutions through NCPDP’s consensus-building process for Specialty prescriptions. Your voice impacts your business and provides value to both you and your company. View Resources at https://ncpdp.org/Specialty-Pharmacy

Documents | Guides and Templates | Informational

ePrescribing Industry Information

ePrescribing Industry Information

Information about electronic prescribing, standards and reference material from the industry

News

NCPDP Hosts Stakeholder Action Group on UPI

NCPDP Hosts Stakeholder Action Group on UPI

NCPDP hosted a Stakeholder Action Group (SAG) last month on the heels of its announcement that 100% of the U.S. population has been successfully enumerated with a Universal Patient Identifier, Powered by Experian Health UIM and NCPDP Standards (UPI).

News

MC Task Group Seeks Input on Proposed Rulemaking: Importation of Prescription Drugs

MC Task Group Seeks Input on Proposed Rulemaking: Importation of Prescription Drugs

The NCPDP Maintenance and Control Education, Legislation and Regulations Task Group is seeking input and feedback from NCPDP members and non-members to review and comment on the FDA “Importation of Prescription Drugs” document. The deadline for commenting on the regulation is March 9, 2020.

Informational

Past Work Group Meeting Recaps

Past Work Group Meeting Recaps

Recaps of previous Work Group meetings for the past 7 years. https://standards.ncpdp.org/WG-Recaps.aspx

Documents

Billing Unit Fact Sheet

Billing Unit Fact Sheet

Introduction to the standard and to provide essential information on the standard. Includes units for "eaches", "grams" and "milliliters"

Documents

Task Group Listing

Task Group Listing

Comprehensive listing of NCPDP active Task Groups

Documents | Guides and Templates

X12N 835 Payment Guidance and Related Documents - Mapping Document

X12N 835 Payment Guidance and Related Documents - Mapping Document

WG45 External Standards Assessment, Harmonization and Implementation Guidance Work Group has prepared a mapping document for consistent use of the Claim Adjustment Reason Codes (CARC), Claim Adjustment Group Codes (CAGC) and NCPDP Reject Codes in the X12 835.

Documents | Guides and Templates

State PMP Tracking Document

State PMP Tracking Document

All states, except Missouri, currently have a prescription monitoring program (PMP). In the absence of a national program, NCPDP Work Group 9 Government Programs created and maintains a document, which provides information on all state PMPs. Information includes the PMP name, schedules monitored, format, batch/on-line, submission methods, reporting frequency, processor, overseeing agency and contact information. This State PMP Tracking Document is updated quarterly.

News

NCPDP’s Pharmacy Outlook for 2020 Published in Chain Drug Review

NCPDP’s Pharmacy Outlook for 2020 Published in Chain Drug Review

Chain Drug Review's special feature, "Pharmacy Outlook for 2020," published last week, includes a contributed article by Lee Ann Stember, NCPDP’s President & CEO.

Press Releases

NCPDP Announces CMS Administrator, Seema Verma, to Deliver Opening Keynote at NCPDP’s 2020 Annual Conference

NCPDP Announces CMS Administrator, Seema Verma, to Deliver Opening Keynote at NCPDP’s 2020 Annual Conference

CMS Trailblazer Verma’s Keynote Will Address Empowering Patients and Health System Transformation to Galvanize Industry to Effect Change at NCPDP’s “Dream BIG, Act NOW” Conference

Documents | Guides and Templates

Medicare Part D

Medicare Part D

Medicare Part D and Payers Supplemental to Part D

News

100% of U.S. Population Has a UPI, Powered by Experian Health UIM and NCPDP Standards™

100% of U.S. Population Has a UPI, Powered by Experian Health UIM and NCPDP Standards™

Every person in the U.S. population, of an estimated 328 million Americans, have been assigned a unique Universal Patient Identifier, powered by Experian Health Universal Identity Manager (UIM) (https://www.experian.com/healthcare/products/identity-management) and NCPDP Standards™ (the “UPI”).

Webinars

NCPDP/HIMSS Town Hall: The Importance for the Healthcare Industry to Establish Universal Patient Identifier

NCPDP/HIMSS Town Hall: The Importance for the Healthcare Industry to Establish Universal Patient Identifier

Learn about the Universal Patient Identifier and current legislative updates, impacts across the industry and how to will improve the healthcare experience for patients and providers.

News

Updated Guidance for SPAPs and ADAP

Updated Guidance for SPAPs and ADAP

NCPDP recently published an updated version of NCPDP Guidance for SPAPs and ADAPs Medicare Part D Coordination of Benefits Requirements and Responsibilities.

Documents

NCPDP Project Development Steps

NCPDP Project Development Steps

A guide to submitting a Project Development Form

News

Get Real-time Access to Legislative and Regulatory News That Impacts Your Business

Get Real-time Access to Legislative and Regulatory News That Impacts Your Business

RxReconn® is NCPDP’s state and federal legislative and regulatory online tracking tool providing subscribers with real-time monitoring of important changes in pharmacy-related legislative and regulatory activity at state and national levels.

Documents

MyNCPDP Member Portal Quick Start Guide

MyNCPDP Member Portal Quick Start Guide

Overview of the navigation and new features for the new Member Portal - MyNCPDP.org website.

Documents

NCPDP Standing Operating Procedures

NCPDP Standing Operating Procedures

This document contains the procedures related to the structure and standards setting process of the National Council for Prescription Drug Programs

Documents

QUIC Form & Guidance

QUIC Form & Guidance

Completed billing unit clarifications

Informational

Standards QUIC Form Resolutions

Standards QUIC Form Resolutions

Request for clarification forms at https://standards.ncpdp.org/Standards-QUIC-Form-Resolutions

Informational

NCPDP Standards Table Data 

NCPDP Standards Table Data 

NCPDP offers the ability to easily download the data from the Data Dictionary and External Code List (ECL). Until now, maintaining the values that support the data elements can be a daunting task for IT and claims management personnel, requiring hundreds of hours of work. NCPDP Standards Table Data provides a cost-effective solution for updating values and definitions that support the various Standards. The NCPDP Standards Table Data files are system generated from the same web-enabled NCPDP Data Dictionary and External Code List into machine-parsable raw data that can be imported into existing applications.

News

NCPDP's Executive Association Tour

NCPDP's Executive Association Tour

Last week, members of NCPDP’s senior leadership team kicked-off NCPDP’s 2019 Executive Association Tour

Documents | Guides and Templates | Informational

Rebate Reference Guide

Rebate Reference Guide

WG7 Manufacturer Rebates has created Reference Guide documents for the Manufacturer Rebate Standard versions v03.02 through v07.01. 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.

Documents | Guides and Templates | Informational

mL Recommendation Resource Document

mL Recommendation Resource Document

NCPDP Recommendations and Guidance for Standardizing the Dosing Designations on Prescription Container Labels of Oral Liquid Medications call to action.

Guides and Templates

Meaningful Use Stage 2: Quality Measure Value Sets from NLM

Meaningful Use Stage 2: Quality Measure Value Sets from NLM

The National Library of Medicine (NLM) Value Set Authority Center (VSAC) provides downloadable access to all official versions of vocabulary Value Sets contained in Clinical Quality Measures that support Meaningful Use Stage 2. The value sets provide lists of the numerical values and individual names from standard vocabularies used to define the clinical concepts (e.g. diabetes, clinical visit) used in the quality measures. Access to the Value Set Authority Center requires a free Unified Medical Language System® Metathesaurus License.

Documents | Guides and Templates

Supplemental Payer Batch N Transaction Information

Supplemental Payer Batch N Transaction Information

Supplemental Payer Batch N Transactions can be submitted to RelayHealth by SPAPs or ADAPs that are not processing claims online, are not using a switch, or have made internal adjustments to their claims outside of the pharmacy.  These batch Information Reporting transactions are forwarded to the Part D plan of record for date of service if they can be matched.

Guides and Templates

NCPDP Processor ID (BIN)

NCPDP Processor ID (BIN)

The NCPDP Processor ID Number (BIN) is a six-digit number that health plans can use to process electronic pharmacy claims if they do not use pharmacy benefit cards with a magnetic stripe. Plans that use cards with a magnetic stripe should use the recommended American National Standards Institute (ANSI) Issue Identifier Number (IIN) for processing electronic pharmacy claims. ANSI issues IIN numbers. NCPDP issues the Processor ID Number (BIN). It is important to understand the difference between the IIN and NCPDP Processor ID Number (BIN) before applying for a Processor ID Number (BIN).

Guides and Templates

Use of the BIN - NCPDP Processor ID

Use of the BIN - NCPDP Processor ID

The Bank Identification Number (BIN) is a term from the credit card industry. It refers to a six-digit number that is assigned to banks for electronic routing of transactions. Credit/debit cards that are involved in banking transactions contain a BIN on magnetic stripe. The term BIN is no longer supported. The number is now called an Issuer Identification Number (IIN). As of January 2017, the IIN length has changed from a 6-digit number to an 8-digit number. Existing six-digit IINs will be converted into a block of a hundred eight-digit IINs. As the majority of issuers are unlikely to need all one hundred of these, they are encouraged to return any unused eight-digit IINs to ANSI.

Guides and Templates

Issuer Identification Number - NCPDP Processor ID (BIN)

Issuer Identification Number - NCPDP Processor ID (BIN)

The term Bank Identification Number (BIN) is no longer supported. The number is now called an Issuer Identification Number (IIN). To obtain an IIN, the American National Standards Institute (ANSI) must be contacted www.ansi.org. On the ANSI web page, enter "IIN" in the Search box. Links will appear for the registration process.

Guides and Templates

Processor Identification Number (Processor BIN) - NCPDP Processor ID (BIN)

Processor Identification Number (Processor BIN) - NCPDP Processor ID (BIN)

In approximately 1989 the pharmacy services sector began using electronic processing for pharmacy claims. This electronic processing of pharmacy claims meant the health plan (or their Pharmacy Benefit Manager/processor/payer on their behalf) needed a number for the electronic routing of transactions. Some health plans decided to use magnetic stripe cards, some did not. Those that use magnetic stripe cards apply to ANSI for an IIN. These numbers commonly begin with "6" as in "610014". Those health plans that did not have a business reason for creating pharmacy benefit cards with a magnetic stripe were in need of a number, because they still needed to process electronic pharmacy claims. NCPDP provides a service to those health plans that do not use magnetic stripe cards. The NCPDP Processor BIN is a six-digit sequential number we assign that begins with "0" as in "000010". We do not reuse numbers. There is a fee to obtain a number.

Documents | Guides and Templates

How to Obtain a Processor ID (BIN) - NCPDP Processor ID (BIN)

How to Obtain a Processor ID (BIN) - NCPDP Processor ID (BIN)

Contact NCPDP Provider Services Department at 480.734.2870 or PharmacyHelp@ncpdp.org, or complete a Processor ID Application. Your number will be assigned and notification will be delivered via fax or email.

Guides and Templates

The Format of the BIN/IIN - NCPDP Processor ID (BIN)

The Format of the BIN/IIN - NCPDP Processor ID (BIN)

The IIN structure is defined within the international standard ISO/IEC 7812-1, Identification cards - Identification of issuers - Part 1: Numbering system. The application and registration procedures are identified in ISO/IEC 7812-2. These standards are developed by the International Organization for Standardization / International Electrotechnical Commission (ISO/IEC) Joint Technical Committee (JTC) 1, Information Technology, Subcommittee (SC) 17, Cards and personal identification, Working Group (WG) 5.

Webinars

The Next SCRIPT Version: What is Changing, What to Expect, and What to Do About It

The Next SCRIPT Version: What is Changing, What to Expect, and What to Do About It

As the industry prepares for the January 1, 2020 implementation date for SCRIPT v2017071, many ePrescribing vendors have started devising their product update plans.

Documents

NCPDP Collaborative Workspace  Important Instructions

NCPDP Collaborative Workspace  Important Instructions

The NCPDP Collaborative Workspace (https://dms.ncpdp.org/) is designed for the NCPDP task groups. It is for the collaborative activity of the pharmacy services and eprescribing sectors of the industry. NCPDP uses this tool for storage of the task group working documents, information on task group calls, and task group notifications. Participants of NCPDP’s task groups agree to abide by the NCPDP antitrust policy and the expected conduct (found on the main site). The NCPDP Collaborative Workspace is a separate website and not tied to the NCPDP membership login of www.ncpdp.org

Documents