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 and the exchange of adjudicated data between business associates.
Work Group 2 Product Identification deals with issues relating to the identification of drugs and health related products within NCPDP’s stated mission. Identification consists of how the product is billed (billing units, quantity designations), product identification systems, and any type of descriptive data which serves to uniquely identify a product with the intent to establish standards for product identification such that there is no ambiguity in distinguishing one product from another.
Work Group 7 Manufacturer and Associated Trading Partner Transaction Standards develops, monitors, and maintains standards for the electronic exchange of data amongst manufacturers and trading partners to facilitate business processes. Additionally, the work group promotes implementation and education of the standards.
Work Group 9 Government Programs, in conjunction with Work Group 1 Telecommunication and other Work Groups, as necessary, guides and advises federal and state pharmacy programs and their agents on NCPDP standards. WG9 also supports data processing initiatives, and provides design alternatives for standards, which support government requirements.
Work Group 10 Professional Pharmacy Services supports the pharmacist’s individual and collaborative planning, delivery, documentation and quality assessment of patient care services through the development and distribution of standards, standards-based templates, and implementation guides. These documents/tools in conjunction with the publication of best practices recommendations encourage patient engagement, foster patient safety and support consistent delivery of patient care services to optimize outcomes.
WG10 strives to support pharmacists in utilizing their unique training and expertise to provide patient care services related to the appropriate use of medications. Patient care services are provided in many different practice settings and include activities such as medication therapy management, clinical reconciliation (medication, allergies and problems), patient immunization management, disease state monitoring, adverse drug event reporting and therapy adherence program management. Pharmacists contribute to improving patients’ health by providing patient care services as authorized by license and allowed under their scope of practice and collaborative practice agreements.
WG45 External Standards Assessment, Harmonization and Implementation Guidance Goals
- Promote NCPDP membership attendance and active participation in work group meetings and task groups.
- Pharmacy ID Cards
- Monitor any initiative to establish a universal healthcare ID card and respond appropriately.
- Continue to collaborate with the International Committee for Information Technology Standards (INCITS) to accommodate standard ID card changes.
- Continue to collaborate with the Workgroup for Electronic Data Interchange (WEDI) to maintain the “Health Identification Card Implementation Guide” containing information for both medical benefits and pharmacy benefits.
- Continue to accommodate changes to the ID card standard, when necessary, to the NCPDP Pharmacy and/or Combination ID Card Implementation Guide.
- Serve as an information source for parties interested in the adoption of the Pharmacy and/or Combination ID Card Implementation Guide standard.
- Respond to government action related to initiatives proposing the use of a standard ID card which are not consistent with either the Health Identification Card Implementation Guide or the NCPDP Pharmacy and/or Combination ID Card Implementation Guide.
- Maintain and modify the NCPDP Pharmacy and/or Combination ID Card Implementation Guide, the NCPDP Health Care Identification Card Fact Sheet and related External Code List as needed.
- Monitor state regulations regarding Pharmacy ID Cards, Discount Cards, and Combination Health Benefit Cards
- Maintain alignment of the NCPDP recommendations and the Claim Adjustment Reason Code (CARC) code mappings with changes to the X12 Incorporated 835.
- Contribute to the development and maintenance of the Operating Rules that impact the pharmacy industry including but not limited to Council for Affordable Healthcare Committee on Operating Rules for Information Exchange (CAQH CORE) and National Automated Clearing House Association (NACHA): The Electronic Payment Association.
- Support Work Group 11 ePrescribing & Related Transactions with the operating rule for the X12 Incorporated 270/271 as needed.
- Discuss and/or present needs as reported by NCPDP members/staff related to the ongoing maintenance of non-NCPDP-developed Health Insurance Portability and Accountability Act (HIPAA) and other transaction data set standards. In response and when appropriate or requested, provide guidance to other work groups and/or develop guidance with respect to the modification of existing NCPDP standards or the development of new NCPDP standards. Affected standards include, but are not limited to, the following transaction data set standards:
- X12 274 Electronic Provider Enrollment Standard
- X12 834 Provider/Member Enrollment Standard
- X12 835 Payment Reconciliation Standard
- X12 270/271 Health Care Eligibility/Benefit Inquiry/Response
- X12 278 Health Care Services Review Request/Response
- X12 Acknowledgements
- Discuss and/or present the needs as reported by NCPDP members/staff in the ongoing maintenance of non-NCPDP-developed Affordable Care Act (ACA) mandated operating rules and associated transactions. These operating rules include, but are not limited to, the following:
- CAQH CORE 350: Health Care Claim Payment/Advice (835) Infrastructure Rules
- CAQH CORE 360: Uniform Use of CARCs and RARCs 835 Rule
- CAQH CORE 370: EFT & ERA Re-association (CCD+/835) Rule
- CAQH CORE 380: EFT Enrollment Data Rule
- CAQH CORE 382: ERA Enrollment Data Rule
- Discuss and provide guidance as needed to other work groups as it relates to impact(s) on existing or future NCPDP standards due to activities or rule changes from other standards setting or advisory organizations. These include, but are not limited to, the Council for Affordable Healthcare Committee on Operating Rules for Information Exchange (CAQH CORE) and the National Automated Clearing House Association (NACHA): The Electronic Payment Association.
- Monitor WG45 task groups to ensure they are tracking scope, goals, and deliverables. Disband task groups that have completed their work.
- Support the MC Maintenance and Control Education-Legislation and Regulation Task Group when new legislation is being introduced regarding issues relevant to the work group.
- Review Designated Standards Maintenance Organizations Change Request System (DSMO CRS) requests as needed.
- Review Data Element Request Forms (DERFs) and adjudicate NCPDP ballots pertaining to standards for which this work group is responsible.
- Analyze, develop and execute Webinar opportunities for WG45 in coordination with Educational Programs Advisors Group.
For a list of acronyms, please see the Acronym Dictionary
WG45 External Standards Assessment, Harmonization and Implementation Guidance Scope
- Work Group 45 External Standards Assessment, Harmonization and Implementation Guidance reviews, assesses and works to continually monitor the development of standards and/or operating rules by other Standards Development Organizations (SDOs) and/or other Non-NCPDP entities that may impact the pharmacy industry. The Work Group:
Communicates SDO and other external entities’ developments and identifies actions that may be needed by this or other NCPDP work groups. These include, but are not limited to, X12 Incorporated Implementation Guides, Health Level Seven International (HL7®) Standards, and International Committee for Information Technology Standards (INCITS).
Develops and maintains guidelines for the pharmacy industry to accommodate pharmacy implementation of the Health Insurance Portability and Accountability Act (HIPAA) and Affordable Care Act (ACA) mandated electronic data interchange (EDI) transactions and operating rules not developed by NCPDP as determined by the membership.
Contributes to the development and maintenance of operating rules that impact the pharmacy industry.
To this end, Work Group 45 External Standards Assessment, Harmonization and Implementation Guidance will collaborate with other SDOs, operating rules entities or other Non-NCPDP entities to provide the pharmacy perspective and represent the industry needs in the development of standards and guidelines.