Work Group 11 ePrescribing & Related Transactions develops standardized messages for prescribers, pharmacists, payers and/or other interested parties to exchange information related to a prescribing event or patient encounter.
Work Group 14 Long Term and Post Acute Care (LTPAC), in conjunction with the other Work Groups, guides and advises payers, processors, and providers of the long-term care industry and institutional pharmacy programs and their agents on standards implementation and supports data processing initiatives.
Work Group 16 Property and Casualty/Workers' Compensation will ascertain, monitor and analyze regulatory requirements to develop and recommend correlating fields to be supported in the Telecommunication Standard format; evaluate, and maintain a Property and Casualty/Workers’ Compensation standard paper claim form; proactively promote and educate pharmacy industry stakeholders and regulatory policy makers on the form and format standards found in Property and Casualty/Workers’ Compensation. This includes but is not limited to uniform billing, state reporting policies and the overall delivery of pharmacy services/care.
Develops, monitors and maintains existing and new standards and guidance for the electronic exchange of data amongst providers, pharmacies, manufacturers, payers/processors and other stakeholders to facilitate patient access to specialty products and related business processes.
The work group, in conjunction with other NCPDP Work Groups, guides and advises stakeholders on standards implementation and supports data processing initiatives. The work group may request modifications to other NCPDP standards as necessary.
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.
WG9 Government Programs Goals
- Promote NCPDP membership attendance and active participation in work group meetings and task groups.
- Provide a forum for members to discuss new federal and state policies and procedures as they relate to the practice of pharmacy and the NCPDP Standards, which may include but are not limited to:
- Medicare Programs (e.g., Medicare Part A, Part B, Part C, Part D, Hospice, End Stage Renal Disease),
- Medicaid and Children’s Health Insurance Program,
- Medicare-Medicaid Plan (MMP) and other dual eligible programs,
- Federal and state-Funded programs (e.g., State Pharmaceutical Assistance Program, Ryan White/AIDS Drug Assistance Program, 340B),
- Federal and state Health Insurance Marketplaces, and
- Cost and reimbursement basis for government programs (e.g., Actual Acquisition Cost (AAC), Usual & Customary (U&C), Wholesale Acquisition Cost (WAC), National Average Drug Acquisition Cost (NADAC), Average Manufacturer Price (AMP), Federal Upper Limit (FUL)).
- Promote and provide support for the use of NCPDP Standards for government programs whether regulated, mandated, or through voluntary industry adoption.
- Review and recommend changes to implementation of the standards development process and regulatory process as related to government programs.
- Collaborate with government agencies to develop and maintain Frequently Asked Questions (FAQs) and Best Practices documents to support the implementation of government programs and associated regulations.
- Maintain the Medicaid Subrogation Implementation Guide for Batch Standard, Prescription Drug Monitoring Programs Reporting Standard and Financial Information Reporting Standard.
- Monitor and track the State Prescription Drug Monitoring Programs.
- Collaborate with Prescription Drug Monitoring programs in identifying and implementing streamlined, innovative and viable electronic solutions.
- Collaborate with the National Medicaid EDI HIPAA Workgroup (NMEH) on issues related to State Medicaid programs.
- Monitor WG9 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.
- Collaborate with other NCPDP work groups and Strategic National Implementation Process (SNIP) Committee as needed.
- Review Data Element Request Forms (DERFs) and adjudicate ballots pertaining to standards within the scope of this work group.
- Analyze, develop and execute Webinar opportunities for WG9 in coordination with Educational Programs Advisors Group.
For a list of acronyms, please see the Acronym Dictionary
WG9 Government Programs Scope
- 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.