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Documents | Guides and Templates

SPAP ADAP Resources

Overview


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.


NCPDP Guidance for SPAPs and ADAPs Medicare Part D Coordination of Benefits Requirements and Responsibilities


This document provides guidance for SPAPs and ADAPs in exchanging data with Medicare Part D Plan Sponsors for electronic coordination of benefits.


CMS SPAP/ADAP List

 

In accordance with Section 50.4.1 of Medicare Prescription Drug Benefit Manual Chapter 14-Coordination of Benefits,  CMS publishes a list of qualified SPAPs and ADAPs on the Coordination of Benefits webpage  at cms.gov. ThMarch 28, 2019 CMS memo titled "Updated Coordination of Benefits (COB) Information" encourages plan sponsors to use this new source of information when coordinating with SPAPs and ADAPs. The list will include SPAPs/ADAPs that have verified data sharing agreements within the Health Plan Management System (HPMS) as of 2019 and forward. CMS will update the list quarterly.


Historical NCPDP SPAP ADAP BIN PCN Spreadsheet


NCPDP maintained an SPAP/ADAP list prior to the publishing of the CMS list in April 2019. The SPAP/ADAP information contained in this spreadsheet was self-reported to NCPDP. The NCPDP spreadsheet will continue to be available for historical information only and it will no longer be maintained by NCPDP.

Final Publication Date: 20190225 SPAP ADAP BIN PCN Spreadsheet 


RelayHealth, CMS Transaction Facilitator Presentations and References


201212 January 2012 SPAP/ADAP Supplemental Claims Data Review presentation 
201504 Supplemental Payer N Transaction Reports


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.

Click here for more information on batching N transactions.


Additional Resources


Medicare Part D Guidance Documents