MC Maintenance and Control monitors and maintains the development of NCPDP standards, implementation guides and reference documents, promotes consistent business and technical administration, makes recommendations to the Standardization Co-Chairs on development procedures, due process compliance, as well as ethical and legal matters. MC provides a forum for updates of work group activities, resolution of inter-Work Group issues and discussion of legislative, regulatory, policy, and court decisions which may affect the pharmacy industry.
WG1 Telecommunication Goals
For a list of acronyms, please see the Acronym Dictionary
- Promote NCPDP membership attendance and active participation in work group meetings and task groups.
- Promote all standards created by this work group including but not limited to the Telecommunication Standard, Audit Standard, Post Adjudication Standard, Prior Authorization Transfer Standard, Prescription Transfer Standard, Benefit Integration Standard, Batch Standard, Subrogation Implementation Guide, Uniform Healthcare Payer Standard and Retiree Drug Subsidy Standard.
- Review Data Element Request Forms (DERFs) and adjudicate ballots pertaining to standards for which this work group is responsible.
- Promote the use of the other transactions in the Telecommunication Standard for eligibility verification, predetermination of benefits, information reporting, controlled substance reporting, and prior authorizations.
- Continue support of the Universal Claim Form (UCF), Workers’ Compensation/Property and Casualty UCF, and supporting Reference Implementation Guide for enhancements to the Telecommunication Standard.
- Provide Health Insurance Portability and Accountability Act (HIPAA) updates.
- Provide responses to technical questions that may be sent to NCPDP as a result of a Notice of Proposed Rule Making (NPRM) for new transactions or enhancements in HIPAA.
- Review Designated Standards Maintenance Organizations Change Request System (DSMO CRS) requests as needed.
- Support WG9 Government Programs and MC Maintenance and Control Education-Legislation and Regulation Task Group when new legislation is being introduced regarding issues relevant to the work group.
- Support a forum for the discussion of Centers for Medicare and Medicaid Services pharmacy issues, as appropriate to WG1 standards.
- Support a forum for the discussion of Food and Drug Administration Risk Evaluation and Mitigation Strategies issues, as appropriate to WG1 standards.
- Monitor WG1 task groups to ensure they are tracking scope, goals, and deliverables. Disband task groups that have completed their work.
- Support task groups of other Work Groups that may impact or utilize the Telecommunication Standard and other WG1 standards to ensure harmonization and interoperability across electronic data exchanges.
- Support the advancement of the appropriate version of the Telecommunication Standard as the next HIPAA adopted version.
- Create a joint task group with WG16 to modify the UCF forms
- Collaborate with WG45 Documents Revision Task Group to ensure alignment with external standards
- Provide assistance to the Strategic National Implementation Process (SNIP) Committee
- Support Maintenance & Control Task Groups with goals and objectives impacting the Telecommunication Standard
- Analyze, develop and execute Webinar opportunities for WG1 standards in coordination with Educational Programs Advisors Group.
WG1 Telecommunication Scope
- Work Group 1 Telecommunication develops and maintains standards and guidelines to accommodate the collection, transmission, and processing of information that may be exchanged electronically or in written formats. The information exchanged may be used for, but is not strictly limited to, such purposes as administering and certifying eligibility, establishing prior authorization for products and services, pharmacy claim billing, payment determination, denial of compensation with explanations, drug use review, determination of benefits and the exchange of adjudicated data between business associates.