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.

The document relates to the current NCPDP Health Care Identification Card Pharmacy ID Card Implementation Guide. The purpose of the fact sheet is to provide details about the NCPDP format and may be distributed to members and non-members. If you have any questions about the fact sheet, please contact Kittye Krempin at the Council office at 480.477.1000 ext. 134.

The document maps the Pharmacy ID Card data fields to the fields in the ASC X12N 270/271 transaction to give the industry guidance on where the fields should be populated should an NCPDP standard-based pharmacy ID card be presented to a prescriber who uses the X12N 270/271 standard to verify eligibility.

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. Click here for a copy of this document.

WG45 External Standards Assessment, Harmonization and Implementation Guidance revision of the Claim Paid but No Financial Transaction Reporting Transaction was completed November 2013. This document provides guidance to the pharmacy sector of the health care industry for reporting pharmacy claims paid at point of sale (POS) but because of an agreement there are no financial transactions exchanged using the X12/005010X221 Health Care Claim Payment/Advice (835) to their long term care (LTC) business partners.

WG45 External Standards Assessment, Harmonization and Implementation Guidance revision of the NCPDP Pharmacy Reference Guide to the X12/005010X221 Health Care Claim Payment/Advice (835) was completed May 2010 and updated in November 2012. The NCPDP Pharmacy Reference Guide to the X12/005010X221 Health Care Claim Payment/Advice (835) document must be used in conjunction with the X12/005010X221 and does not supersede it. The reference document is meant to supplement the provider manuals that payers build. Payers can use this document to convey the important features of supporting the X12/005010X221 to their business partners.

WG45 External Standards Assessment, Harmonization and Implementation Guidance Work Group has prepared a White Paper as guidance to the pharmacy industry to prepare for the implementation of the X12/005010X221 Health Care Claim Payment/Advice (835).

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.

WG45 External Standards Assessment, Harmonization and Implementation Guidance revision of the Payer Audit Reporting Transaction was completed October 2019. This document provides guidance to the pharmacy sector of the health care industry for reporting the outcome of a payer initiated post payment audit and adjustment of pharmacy claims using the X12/005010X221 Health Care Claim Payment/Advice (835).

WG45 External Standards Assessment, Harmonization and Implementation Guidance revision of the Low Income Subsidy (LIS) Reporting Transaction was completed August 2012. This document provides guidance to the pharmacy sector of the health care industry for reporting the outcome of a payer initiated retro-active Low Income Subsidy (LIS) adjustment of pharmacy claims using the X12/005010X221 Health Care Claim Payment/Advice (835) to their long term care (LTC) business partners.

WG45 External Standards Assessment, Harmonization and Implementation Guidance revision of the Central Pay Transaction was completed October 2014. This document provides guidance to the pharmacy sector of the health care industry to convey a consistent solution for recovering overpayments from a Central Pay Prescription Service Administration Organization (PSAO) and/or financial intermediary via the X12/005010X221A1 Health Care Claim Payment/Advice (835).

WG45 External Standards Assessment, Harmonization and Implementation Guidance Work Group has created the NCPDP Direct/Indirect Remuneration (DIR) 835 Reporting Recommendations document. Payers may use this document to convey a consistent solution for identifying Direct and Indirect Remuneration (DIR) adjustments of pharmacy claims using the X12 005010X221A1 Health Care Claim Payment/Advice (835) to their provider business partners. The document should not be used as a standard form by a payer to provide information that is important to pharmacy providers, pharmacy reconciliation vendors and other implementation units.

National Health Plan ID

NCPDP SNIP (Strategic National Implementation Process) Committee provides HIPAA implementation guidance to the pharmacy industry. The committee answers questions, develops guidelines, provides transition assistance and develops educational material. NCPDP SNIP is a sister committee to the WEDI SNIP (Workgroup for Electronic Interchange) which is addressing HIPAA implementation for the non-pharmacy industry and receives input from the pharmacy industry via this committee.

The NCPDP 340B Information Exchange Reference Guide was developed to meet the industry needs for electronic communication between trading partners of an individual prescription or prescription claim’s status under the 340B drug pricing program. Click here for a copy of this document.

NCPDP WG10 Professional Pharmacy Services has developed the Pharmacist eCare Plan Version 1.0: Guidance on the Use of the HL7 CDA Consolidated Templates for Clinical Notes R2.1 Care Plan to enable pharmacists to capture their assessments of patient health status and health concerns, mutually defined patient care goals, recommendations, interventions and outcomes and to share them with other care providers, payers and the patient.

NCPDP WG10 Professional Pharmacy Services has developed Recommendations for the Use of HL7 Consolidated CDA Templates for Pharmacy to provide guidance to the pharmacy sector on the use of the HL7 Consolidated CDA template document format as the vehicle for capture and exchange of the pharmacist clinical information. Content of two document formats are included: Transition of Care Between Inpatient and Community Pharmacy and the Pharmacy/Pharmacist Care Note (PCN).

NCPDP WG14 LTPAC has developed the Consultant Pharmacist Consult Note guidance document for exchange of the pharmacist’s recommendations with the appropriate LTPAC facility staff and the physician(s) of record for the patient. This paper is based on the C-CDA Consult Note Document Template.

The Signature Log is available to members as guidance. Click Here for the log and instructions.

Guidance on the use and application of NCPDP standards to meet the business requirements in the Workers’ Compensation Insurance environment. This document includes a glossary of workers’ compensation related terms, FAQs, and guidance on “Brand/Generic Selection and Invoicing When Both the Brand and Generic NDC and Cost Must Be Present” and “Assignment of Jurisdictional Fields”. Periodic additions are anticipated as new business issues are brought forward. Developed by NCPDP Work Group 16: Property & Casualty and Workers’ Compensation. Workers Compensation Guidance Document

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

NCPDP Work Group 9 developed the white paper The Proper Use of the NCPDP™ Telecommunication Standard Version D.0 as it applies to the Implementation of Medicaid Reimbursement Methodologies Based on Actual Acquisition Cost (AAC) Plus a Professional Dispensing Fee to provide Medicaid agencies and fiscal agents guidance in implementing new acquisition cost based reimbursement rules for covered outpatient drugs. The paper presents common issues experienced to-date in implementing cost based reimbursement with professional dispensing fees. It highlights how to best utilize the NCPDP Telecommunication Standard Version D.0 and leverages best practices for various scenarios such as preferred brands for multisource generic situations and the proper use of the Dispense As Written (DAW)/Product Selection Code (408-D8) field values to inform pharmacies of formulary requirements.

NCPDP Work Group 1 developed the Upstream Reporting of Copay Assistance Issues Brief to document the results of task group research into the topic but does not provide recommendations or solutions. The research includes:

• • Program types
• • Possible use cases
• • Viability of using the NCPDP Telecommunication Standard Information Reporting (Nx)
• • Transaction
• • Other Obstacles to solutions