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DOCUMENTATION FOR FEBRUARY 2015
JOINT TECHNICAL WORK GROUP MEETINGS
For a listing of meetings, dates, times, and agendas, please visit the NCPDP web site at
http://www.ncpdp.org/Events/Work-Group-Meeting.
To help prepare for the work group meetings, documentation is available on the NCPDP web site. The
agendas link is above. The MC Maintenance and Control page link is below. The individual work group
pages of working documents are below. Review of the documentation prior to the meeting will provide
helpful background.
Please make sure you bring copies with you, as copies will not be provided. Some documents are still
being developed and may not yet be available on the specified page. Please check back before work
group meetings.
DERFS AND NEW PROJECT DEVELOPMENT FORMS:
Any Data Element Request Forms (DERFs) and New Project Development Forms submitted for review at
the Joint Technical Work Group Meetings, scheduled for February 4-6, 2015 in Long Beach, CA are
available on the website. To view and download the DERFs, log in to the website as a member, go to
Work Group Lookup, select MC Maintenance and Control page and scroll down for the DERFs. For access
to the information, either download the ZIP file containing all the DERFs and New Project Development
Forms, or click on each item and download a copy. If you have any questions or need clarification on a
DERF, please contact the Work Group Co-Chairs or the individual identified in the “submitter” section of
the DERF.
Note that the following DERFs are External Code List (ECL) requests and will be discussed in the Work
Group identified and voted on in MC Maintenance and Control. The Standardization and MC Co-Chairs
determined these changes warranted work group review.
DERF 001241/ECL 000170
DERF 001242/Emergency ECL 000171
DERF 001243/Emergency ECL 000172
DERF 001244/Emergency ECL 000173
DERF 001246/ECL 000174
DERF 001247/ECL 000175
Please review the DERF/External Code List Process at http://www.ncpdp.org/NCPDP/media/pdf/FlowFor-DERF-website.pdf. If you are unable to attend the work group meeting, but have substantive
comments on the DERF/ECL, please send those comments to the assigned Work Group Co-Chairs and
Liaison.
The final review of all DERFs is held in MC Maintenance and Control where modifications may be made.
Pended
Request
WG
DERF/ECL #
Reviewing
DERF
1
001213
This DERF requests, "This DERF proposes the addition of new response fields
to enhance the information returned on an Accepted (D1)/Paid/Captured
(B1) or duplicate Paid/Captured (B1) response. These new fields will include
values that will improve the communication between the pharmacy,
prescriber and beneficiary to allow the beneficiary to understand and access
their benefits appropriately. Please also see other ECL DERF which requests
adding new values to the Approved Message Code Field (548-6F). Specific
Approved Message Code values are to be used in conjunction with each of
the attached new response fields. Until the applicable version of the NCPDP
Telecommunication Standard to which these new response fields will be
available for use, the information associated to the new Approved Message
Code Values would be returned in the Additional Message Field (526-FQ),
qualified with the new applicable Additional Message Information Qualifier."
WG1
001214
ECL 000164
This DERF requests, "This DERF proposes the addition of new Approved
Message Code Values (548-6F) and Additional Message Information Qualifier
Values (132-UH) to the External Code List to enhance the information
returned on an Accepted(D1)/Paid/Captured (B1) or duplicate Paid/Captured
(B1) response. These new values/descriptions will improve the
communication between the pharmacy, prescriber and beneficiary to allow
the beneficiary to understand and access their benefits appropriately."
WG1
001223
This DERF requests, "The MC Unique Device Identifier (UDI) Task Group has
reviewed the NCPDP Standards and Implementation/ Reference Guides and
determined the following changes need to occur to support the use of the
UDI. Please see separate documentation for the changes necessary for the
following documents:
External Code List (also XML Schema Changes)
Manual Claim Form Reference Implementation Guide
Telecommunication Standard Implementation Guide
Prescription Transfer Implementation Guide"
MC
(of interest
to
WG1/WG11)
001232
This DERF requests "Add Patient to the Medication Level of the
<RXHISTORYRESPONSE> in <MEDICATIONPRESCRIBED>,
<MEDICATIONDISPENSED> and <MEDICATIONDISPENSEDADMINISTERED>.
This would be an optional segment in <MEDICATIONPRESCRIBED>,
<MEDICATIONDISPENSED> and <MEDICATIONDISPENSEDADMINISTERED>. It
will use the standard Patient type. An annotation would also need to be
added to the schema stating that Patient at Medication Level would only be
sent if the information is different than the Requested Patient."
WG11
001236
This DERF requests "Revision to the MTM sections of Specialized
Implementation Guide to reflect requests for MTM and/or Pharmacist
Professional Services by entities other than the payer. Edits are made to 1.1,
1.1.1,1.1.2 and 1.1.3.1. New sections 1.1.1.2 and examples at sections 1.7.1.7,
1.7.1.8, 1.7.1.9, and 1.7.1.10."
WG10
New
DERF/ECL #
Request
WG
Reviewing
DERF
001240
This DERF requests, “Expand the length of the Transaction Reference Number
field from 10 to 30 in the Data Dictionary. The field is used in the Telecom
and Batch Standards.”
WG1
2
001241
This DERF requests, “The Sig In Transaction Task Group, under Maintenance
& Control, is requesting the addition of an Audit Element Type to the NCPDP
Audit Standard to accommodate a request for Prescription Directions (Sig).”
WG1
001242
This DERF requests, "This Emergency ECL DERF requests a new Submission
Clarification Code (420-DK) value to support Medicare Part D prescriber
enrollment validation requirements and the associated hierarchy of rules,
when the plan’s prescriber data base is unable to identify an active state
license with prescriptive authority for Prescriber ID Submitted and returns
reject code 777."
WG1
(of interest
to WG9)
001243
This DERF requests, "This Emergency ECL DERF requests a new Submission
Clarification Code (420-DK) value to support Medicare Part D prescriber
enrollment validation requirements, when the prescriber is a pharmacist with
prescriptive authority, per state law."
WG1 (of
interest to
WG9)
001244
This DERF requests, "This Emergency ECL DERF requests an update to the ECL
Value Description Definition and Limitations for Submission Clarification Code
value 49."
WG1
(of interest
to WG9)
001245
This DERF requests, "For a NEW Telecomm standard, request for a NEW field
called Reconciliation ID. Definition: A unique identifier assigned by processor
that provides a means by which provider and processor are able to identify
the claim should subsequent activity following approval be warranted. The
primary need is for reversal processing when multiple transactions for the
same prescription occur on the same day (COB, different refill, partial fill,
etc.). On a reversal, the Reconciliation ID should be used with the Service
Provider Id to find the exact claim requested for reversal. Additionally, the
Reconciliation ID should be provided on an 835 remittance advice which can
assist providers with reconciliation of payment."
WG1
001246
This DERF requests, “Reject Code 27 - Product Identifier not FDA/NSDE Listed
was added to the ECL for use within the Telecommunication Standard as of
07/2014. The intent of this Reject Code was to replace Reject Code 54 – NonMatched Product Service ID which was the recommended code value to use
with NCPDP v5.1, when the product was not on the NSDE file. It has been
found however, that Reject Code 27 does not clearly identify the status of the
drug product on the NSDE file. As a result, the pharmacy is unable to initiate
the appropriate action. For example, Reject Code 27 is currently being
returned when: The drug product is on the NSDE file; however the claim date
of service is after the product’s Market End Date (MED); The product is on the
NSDE file; however the claim date of service is prior to the product’s Market
Start Date (MSD). As a result of the discrepancies found between the actual
product in circulation and the NSDE Market End and Start Dates, and data file
timing delays, the pharmacy provider attempts to make an outreach to the
manufacturer to ensure the NSDE information is accurate. This process
expedites patient access to care and can mitigate future rejects for the same
product. In order to accurately reflect the cause of the claim rejection to the
manufacturer a new distinct reject code is needed. This DERF is requesting a
new reject code."
WG1
(of interest
to WG9)
3
001247
This DERF requests, “Need to change the existing field, Health Card ID Card
Qualifier Code, by adding a new value, to show service-connected status on
the magnetic stripe of the Veteran Health Identification Card (VHIC).
Disability compensation is a monetary benefit paid to Veterans who are
determined by VA to be disabled by an injury or illness that was incurred or
aggravated during active military service. These disabilities are considered to
be service-connected. Service-connection provides a higher priority status to
Veterans in the VA health care system. They are entitled to additional
benefits, such as reduced or cost-free copayments for VA health care. They
can also receive special services, such as free or reduced cost access to
parking at VA medical facilities. The VHIC enables Veterans to receive quicker
and more efficient services from VA health care facilities. Service-connected
status is indicated on the face of the VHIC, for those that have it. However, it
is not contained on the magnetic stripe of the VHIC, as there is not a code
available to show service-connected. Currently there is not a machine
readable method to present the service-connected status of a Veteran to the
VA health care medical records and other information systems. We would
like to have a code, SC, added as a Data Element as a Health Card ID Qualifier
Code, to indicate a service-connected status for a Veteran.”
WG3
001248
This DERF requests, “With the increased legalization of marijuana for medical
or recreational use, knowing whether or not a patient is a Cannabis user is
important clinical information that should be exchanged. This DERF proposes
to add a field "Cannabis User" so that prescribers and pharmacies can share
this data point.”
WG11
(of interest
to WG10)
001249
This DERF requests, "Request to modify the SCRIPT Implementation Guide
specific to Resupply."
WG11
001250
This DERF requests, “There is a need to be able to report a program specific
SCORES composite on the Medication History Response for use in a response
from a PDMP entity. The composite will have a 0 to Many relationship."
WG11
001251
This DERF requests, “Modifications to the examples in the SCRIPT
Implementation Guide to align with the recommendations for Quantity as
found in the SCRIPT Implementation Recommendations document.”
WG11
001252
This DERF requests, “The Standardization Committee has requested that
language around Steering be removed from the SCRIPT Implementation
Guide since it is not appropriate for NCPDP to give this guidance. The second
paragraph of Section 3.2 Compliance - is where this language is found. Since
the 1st paragraph is outdated and the 3rd paragraph is stating the obvious
the whole section should be removed."
WG11
001253
This DERF requests, “Through the work of the S&I Framework Prescription
Drug Monitoring Program & HIT Integration Initiatives, a few enhancements
have been recommended for Medication History Request & Response which
is one of the named standards for the current pilot.”
WG11
001254
This DERF requests, “Add datatypes:PHARMACISTID to the Pharmacist under
Pharmacy in the following elements in structures: MANDATORYPHARMACY,
OPTIONALPHARMACY, PHARMACY, PHARMACYTRANSFER (?)”
WG11
4
001255
This DERF requests, “During a Workers’ Compensation Electronic Health Care
Transactions Symposium last November, a gap in the NCPDP Standards was
identified. With the increase in electronic prescribing, the patient’s
prescription is processed and ready for pick-up rather than being dropped off
where traditionally a patient is asked if the prescription is work or auto
related. This is resulting in an increasing number of work and auto related
injuries being incorrectly billed to commercial and government programs.
This problem could be reduced by adding an indicator to the SCRIPT Standard
where the prescriber would communicate to the pharmacy whether the
prescription is work or auto injury related. Need to include in implementation
guide a note that "this is flag should be sent only when the prescription is
related to a Worker Compensation, auto or other third party injury.” The
element would be optional and in all occurrences of MEDICATIONPRESCRIBE
except it will not be used in RXHISTORY.”
WG11
(of interest
to WG16)
001256
This DERF requests, “Current guidelines in NCPDP IG on "deferral" are causing
confusion as NCPDP IG recommends to use a separate Reason Code,
“OTHERREASON” listed under <OPEN> STATUS CODE, to convey that a PA
case is being deferred. As “deferral” is a scenario where a PA case is either
being deferred or pended for more information from the doctor office and
also based on the definition of “deferral” in the “Deferral Policy” document,
it is clear that single element <MOREINFORMATIONREQUIRED> is enough to
support all the business use cases of the industry at the moment. The
recommendation is being made to remove both <OTHERREASON> and
<REASON> codes from the list and move <MOREINFORMATIONREQUIRED>
along with all the sub-elements under “PAOPENTYPERESPONSE”. Also, there
is a recommendation to add some verbiage on the usage of “OPEN”
response. Having a single code will remove ambiguity that exists today as a
result of the existence of 2 Reason Codes for the same use case.”
WG11
001257
This DERF requests, “Vendors have requested a more explicit method for
removing/deleting F&B files than the current process. This DERF compliments
the existing file management rules by providing vendors with an explicit file
expiration date. The Expiration Date represents "Do Not Use/Delete"
information tied to the specific F&B files. The new "List Expiration Date" field
will be added to the following files, after the List Effective Date:
* Formulary Status Header
* Cross Reference List Header
* Formulary Alternatives Header
* Coverage Information Header
* Copay Header.”
WG11
5
001258
This DERF requests, “The F&B Task Group is recommending the adoption of
the Pharmacy Network File set as part of the F&B Standard. With the growth
of Preferred Pharmacy Networks, providers and their patients have a greater
need to understand which pharmacies are in network and the impact of
pharmacy networks with copays. They consist of the following files:
*Pharmacy Network Header* Pharmacy Network Detail* Pharmacy Specific
Drug (Different DERF)* Pharmacy Chain Codes (Different DERF)* Changes to
the existing Copay Summary and Detail Files (Different DERF)The Pharmacy
Network (PN) files function similarly to the Formulary Files; they contain a
Header that indicates the general rules and any exceptions are contained in
the Detail portion of the Standard. For consistency to all providers, we will
also use a slightly modified Formulary Status concept and apply it to PN Files.
The Pharmacy Detail Section also supports a Maximum Day Supply field,
typically a 90-day at Retail option tied to the member benefit.”
WG11
001259
This DERF requests, “The F&B Task Group is recommending the adoption of
the Pharmacy Network File set as part of the F&B Standard. With the growth
of Preferred Pharmacy Networks, providers and their patients have a greater
need to understand which pharmacies are in network and the impact of
Pharmacy Networks with copays. One consistent complaint regarding the
F&B Standard is about the amount of data being sent to correctly represent
F&B information. To support Pharmacy Networks, over 70,000
NCPDPIDs/NPIs may be used to represent a single network. Headers can help
reduce the file size though it alone is not enough. By using a Chain Identifier,
a single ID can reduce the list by thousands of records. Since there is not a
standard Chain ID in the industry, this is an opportunity to start creating a
centralized list to reduce file size. This DERF provides a method to identify
pharmacy chains so that only one ID is required to represent thousands of
stores. It will be ECL-based to allow faster support of additional chains and
pharmacy consolidation.”
WG11
001260
This DERF requests, “The F&B Task Group is recommending the adoption of
the Pharmacy Network File set as part of the F&B Standard. With the growth
of Preferred Pharmacy Networks, providers and their patients have a greater
need to understand which pharmacies are in network and the impact of
Pharmacy Networks with copays. One consistent complaint regarding the
F&B Standard is about the amount of data required to correctly represent
F&B information. To support Pharmacy Networks, over 70,000
NCPDPIDs/NPIs could be used to represent a single network. Headers can
help reduce the file size though it alone is not enough. By using a Chain
Identifier, a single ID can reduce the list by thousands of records. This
approach recommends allowing payers to send specified list(s) of Pharmacy
Chain IDs and their respective individual Pharmacy Codes. This option
supports payers' current process and obviates the need for a centralized
Chain Pharmacy List.”
WG11
6
001261
This DERF requests, “The F&B Task Group is recommending the adoption of
the Pharmacy Network File set as part of the F&B Standard. With the growth
of Preferred Pharmacy Networks, providers and their patients have a greater
need to understand which pharmacies are in network and the impact of
Pharmacy Networks with copays. To support Preferred Pharmacy Status, the
existing Copay File structure needs to be modified by adding the Pharmacy
Network Field to both the Copay Summary and Detail Files. The Pharmacy
Network Fields will be added after the Pharmacy Type Fields. The field will be
optional since many benefit structures may not have a Preferred Pharmacy
Network.”
WG11
001262
This DERF requests, “The F&B Task Group is recommending the adoption of
the Pharmacy Specific Drug file (PSD). The PSD file identifies where a
prescription should be sent, primarily used for Specialty Pharmacies and
drugs with limited distribution. This file is drug specific and overrides the
pharmacies indicated in the 271 Eligibility Response and the Preferred
Pharmacy Network. The Preferred Pharmacy Network files should support
the Limited Distribution Pharmacy Listing.Conceptual layout (detailed
example attached):* Each row identifies the drug and pharmacy* A single
drug may have more than one pharmacy* Preferred Pharmacy Network
Status may be indicated (optional depending on usage of the Preferred
Pharmacy Standard).”
WG11
001263
This DERF requests, “The F&B Task Group is recommending the addition of a
Specialty Drug Indicator to the F&B Files. This indicator will inform the
provider that the selected item is considered a Specialty Drug should provide
additional supporting information using other file types from the F&B
Standard. The Specialty Indicator will be included as a New Coverage
Information Detail Type. The recommendation is to add a new 'SD' Code for
Specialty Drugs. In addition, the External Code List must be updated to
include a Specialty Indicator for Text Message and Resource Link Type. The
ECL should add a new line:
Name of Value: Indicates a Specialty Drug, typically high-cost, scientifically
engineered drugs used to treat complex, chronic conditions that require
special storage, handling, and administration, and involve a significant degree
of patient education, monitoring, and management.
Value: SD - Specialty Drug
Supported for both Text Messages and Resource Links.”
WG11
7
001264
This DERF requests, “This DERF requests that the diagnosis(es) associated to
the prescription must be included on all transactions identified below.
Requiring the diagnosis will assist in patient care, as pharmacists will have
accurate information to support medication management, and can be used to
expedite the request and processing of prior authorization. It is
acknowledged that the diagnosis provided may differ from the indication
included in the Structured and Codified Sig, as the indication may be provided
in patient-friendly terms. This DERF is specifically addressing the inclusion of
the diagnosis. From the Implementation Recommendations Document - 3.7.4
Inclusion of Diagnosis: SCRIPT Version 10.6 has a field for a Primary and
Secondary Diagnosis Code in the Prescribed Medication Segment, which is
optional and infrequently populated. EHR/Eprescribing vendors are
encouraged to populate this field with the diagnosis(es) associated to the
prescription when transmitting all prescriptions to the pharmacy. By doing
this, the industry will improve patient safety, enhance efficiency and expedite
prior authorization. As it pertains to Specialty, inclusion of this information
will reduce the need for the pharmacist to contact the prescriber for missing
information such as that is needed for prior authorization, claim processing,
or manufacturer-required reporting.”
WG11
001265
This DERF requests, “This DERF proposes to add a number of elements, and a
new Segment (Agency) to support e-prescribing of specialty medications.
These are optional elements that are intended to be used to replace the
current manual processes employed when prescriptions are sent to specialty
pharmacies.”
WG11
001266
This DERF requests, “This DERF is to request that SCRIPT be modified to
support Prescription Benefit Inquiry and Response Transactions for use to
obtain patient specific benefit information based on the selected pharmacy,
drug, and days supply. See additional documentation -Schema, draft NCPDP
Guide updates, and PowerPoint.”
WG11
001267
This DERF requests, “Due to challenges in the Long Term and Post-Acute Care
settings there is a need to update the Census Message. See additional
documentation for details.”
WG11 (of
interest to
WG14)
001268
This DERF requests, “Request to add additional REASONCODE values for use
in <RXFILL><NOTDISPENSED><REASONCODE> and the reinstatement of
current values for RXFILL - NOTDISPENSED. It also requests the addition of
<REASONCODE> to be added to <DISPENSED> and <PARTIALLYDISPENSED>.
See attached document for details.”
WG11
8
001269
This DERF requests, “Current Physician Monthly Order Recertification
Procedure is a manual paper method and adheres to state regulations.
Business need: For a physician to recertify monthly electronically using
NCPDP SCRIPT while meeting any and all state regulations, reducing paper
audit trail, and streamlining the recertification activity. Proposed solution:
Create new message, Recertification Transaction. Recertification Transaction
definition: A notification from a facility, on behalf of prescriber, to a
pharmacy recertifying a patient’s prescription order per established recertify
period. Use case: physicians must review and recertify a patient’s medication
regimen on a regular basis for the continued use of open-ended orders
(medication orders without an <EXPIRATIONDATE>). This recertification
period (typically every 30 or 60 days) varies by state regulations and facility
practice, but must be documented and available to the pharmacy. The
Recertification Transaction meets this need by providing the capability to
authorize the continued dispensing of the medication order. This signifies the
physician recertification approval. See attached documentation for details.”
WG11
001270
This DERF requests, "For the first time in 2015, biosimilars will be dispensed
or administered to patients in the US on the basis of a physician prescription.
In seven states, there are requirements to report the biologic dispensed back
to the prescribing physician. While state rules do not yet require this to be in
an electronic transmission, this proposal allows the dispensing or
administering organization to communicate back NDC and lot numbers as
part of a standardized electronic transaction. Both NDC and lot number,
similar to vaccine administration, are also an aid in identifying adverse drug
events for a biologic or biosimilar product. Adverse Drug Events often go
unreported by physicians and other providers. A common reason is that the
EHR system at the physician's practice or Long-Term / Post-Acute Care facility
does not have sufficient dispensed medication detail needed for such
reporting. The dispensed product's NDC and lot numbers are a critical piece
of information needed for the Adverse Drug Event report. This proposal adds
the existing product lot number in the Specialized Standard to the Dispensed
Medication Composite in two SCRIPT transaction types--RXFILL and
RXHISTORYRESPONSE--as an optional element to be populated only when
communicating dispense information related to biologic and biosimilar
products. The change enables the RXFILL and RXHISTORYRESPONSE messages
to be used to convey dispensed drug details for all medications including
biologics and biosimilars--giving providers in the patient care setting the
information needed to report adverse drug events when they occur. The
process would benefit from manufacturer information to confirm the NDC
and lot number since NDC number use has a history of being less than
foolproof. This proposal also adds a new Manufacturer Name field to the
Medication Dispensed Composite in these transactions. The field would be
long enough to hold the full manufacturer name."
WG11
(of interest
to WG10)
9
001271
This DERF requests, "The Formulary Status File today contains a concept of a
preference level. This is a field that is mixed with Formulary Status. When
this is used with a Copay File to determine a summary level Copay it would be
helpful to have a separation between true Formulary Status (On or Off) vs.
the Preference. The Formulary Status File should have a new field added that
is simply Formulary Status and the values would be On or Off. The current
Formulary Status value can be used for Preference only and the values can
remain the same."
WG11
001272
This DERF requests, "The Formulary and Benefit Copay Summary File should
be expanded to include the following values which would enhance the
granularity and accuracy of copay data that can be provided.1. Product Type
Field – add Multi-Source Brand Classification2. New field to accommodate
copays based on total approved dollar amount.Example:Example 1: $0 copay
for drugs costing less than $25.00 and a $10.00 copay for anything $25.00 or
aboveExample 2: $10 copay for drugs costing 500.00 or less and a 10% copay
for anything over $5003. New field to accommodate copay changes due to
RRA limits ExampleExample 1: for up to 2 fills the member can get a drug for
a $10.00 copay after the 2 fill the member pays 50%Example 2: for up to 3
fills the member can get a drug for a $20.00 copay after the 3 fill the member
pays $50.004. New field to accommodate copays based on number of
units.Example 1: Drugs A and B the copay is $20.00 for 5 units (pills) or less;
for units 6-10 the copay is $30.00 and over 10 is $40.005. New field to
accommodate Medicare copay stage as a qualifier field, values would relay
copay during initial coverage, gap, catastrophic and deductible."
WG11
001273
This DERF requests, "The F&B Standard needs to expand the ability to
designate copays based on other components than are available in the
standard today. The concept of Price Points exists and is tied to the drug
formulary grouping. Both the Formulary Status File and the Summary Level
Copay File need a field for Price Point added. The potential values for price
point could be 1-99."
Request
WG11
New Project
000039
This project requests, "NCPDP should review all of the following standards
and guide the industry towards implementing any or all of them as a Public
API (Application Programming Interface):
--Functional Profiles for Electronic Health Record (EHR) Systems
--Formulary and Benefit
--SCRIPT
--Specialized Standard (Census, Medication Management Therapy, Other
Patient Care Service and Query)"
WG
Reviewing
DERF
MC
OF SPECIAL NOTE
Joint Meeting of WG1/WG2/WG11
A joint meeting of WG1/WG2/WG11 will be held Friday, February 6, 2015 from 8:00 a.m. to 12:00 p.m.
to discuss FDA/SPL REMS. As part of the reauthorization of the Prescription Drug User Fee Act (PDUFA),
FDA has committed to standardizing Risk Evaluation and Mitigation Strategies (REMS). Project 3 of the
FDA’s proposed strategies is to include REMS information into pharmacy systems by using the
10
Structured Product Labeling (SPL). At this joint meeting, discussions will be held to define next steps for
all three Work Groups, solicit feedback on implementation and define detailed use cases.
Frequently Asked Questions (FAQ) Documents
Multiple task groups develop Frequently Asked Questions documents for Work Group review and
publication. These FAQs should be reviewed during task group calls and prior to Work Group meetings
as discussion time is limited.
Ballot Responses
The results of the recirculation ballot will be reviewed as follows:
WG11 – Ballot WG110062R
The ballot results will be posted to the appropriate Work Group web page just prior to the Work Group
meetings.
SPECIFIC WORK GROUP DISCUSSION ITEMS:
Documents for discussion during specific Work Groups will also be available to members on the NCPDP
web site, on their respective work group pages. If you are interested in (or think you may attend) a work
group(s), go to the specific work group page and download or print any documentation for February 4-6,
2015 meetings. Please make sure you download/bring copies with you, as copies will not be provided.
The detailed work group documentation is accessible from the Member Portal page
http://www.ncpdp.org/members/member-info.aspx. Select the work group from the dropdown at the
left side of the screen.
On each Work Group page you will see the February 2015 Meeting Materials with a zip file.
Download the zip file.
Previous meeting minutes are also available on each page. Please note you may need to check
work group website pages just before work group meetings, as recent work is being posted in
the zip files, as well as the ballot results.
WG1 Telecommunication
Work Group 1 Telecommunication develops and maintains standards and guidelines to
accommodate the collection, transmission, and processing of electronic pharmacy claim
information, i.e. administering and certifying eligibility, prior authorization, and prescribing drug
benefits for traditional, managed care, and government programs; billing; payment or denial of
compensation with explanations, and concurrent drug use review.
During the February Work Group meetings, WG1 will hear updates from the following task
groups:
 Telecommunication FAQ Task Group
 Coordination of Benefits (COB) Task Group
 Financial Information Reporting Task Group
 Information Reporting Problems Task Group
 Post Adjudication Task Group
 Definition of a Valid Prescriber Task Group
 Supplemental Payer Reporting Task Group
 Eligibility Verification Enhancements Task Group
 Transaction ID Task Group
 Compound Billing Solutions Task Group
 Vaccine Services Task Group
 Benefit Integration Task Group
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
Standardized Subrogation Task Group
WG1 will also:
 Discuss new DERFs
 Discuss questions and answers from various task groups for inclusion in the Version D
Editorial document and/or Telecommunication Implementation Guide
 Discuss questions and answers for inclusion in the Financial Information Reporting
Editorial document (if applicable)
 Discuss action items from any task group
 Hear an update from NCPDP SNIP Committee
 Continue discussion of the steps and a timeline for next version of Telecom, Batch, and
Subrogation Standards in HIPAA
Documents for discussion that are on the WG1 page include:
 201502.WG1.zip containing:
o Agenda
o New Telecommunication Frequently Asked Questions (if applicable)
o New COB Frequently Asked Questions (if applicable)
o New Financial Information Reporting Questions (if applicable)
o New Definition of a Valid Prescriber Questions (if applicable)
o Draft documents for consideration of the next version of HIPAA – timeline, analysis
items, and changes since version D.0 documents
o Task Group Recaps
 See web page for all available documentation.
WG2 Product Identification
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.
During the February Work Group meetings, WG2 will hear updates from the following task
groups:
 Dates Associated With Pharmaceutical Products Task Group
 Structure Product Labeling Activities Task Group
 Product Review and Billing Unit Exception Task Group
 NCPDP Product Identifier Standard Task Group
 SPL REMS Task Group
 Review of Appendix B Reference Code Qualifiers Task Group
 Naming Standards for Drugs, Biologics and Biosimilars Task Group
 Application of BUS Clarification Task Group
 Update Joint WG2/WG11 Task Group
 Update on MC NDC Depletion Task Group
WG2 will also:
 Hear an update on the Industry and Government Activities
 Review new QUIC forms
Documents for discussion that are available on the WG2 page include:
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

201502.WG2.zip containing:
o Agenda
o New QUIC Forms
o Task Group Recaps
See web page for all available documentation
WG3 Standard Identifiers
Work Group 3 Standard Identifiers develops, educates, and promotes the adoption of standard
identifiers for pharmaceutical data transactions, healthcare providers, and benefit delivery
systems, i.e. identification cards.
During the February Work Group meetings, WG3 will hear updates from the following task
groups:
 Pharmacy ID Card Implementation Guide Task Group
 Health Plan Identifier (HPID) Task Group
WG3 will also review updates from WG1’s Valid Prescriber Task Group and WG9’s Fraud, Waste
and Abuse Training Attestation Task Group.
Documents for discussion that are on available on the WG3 page include:
 201502.WG3.zip containing
o Agenda
o Task Group Recaps
 See web page for all available documentation
WG7 Manufacturer and Associated Trading Partner Transaction Standards
Work Group 7 Manufacturer and Associated Trading Partner Transaction Standards develops,
monitors, and maintains standards for the electronic exchange of data between manufacturers
and data providers, and/or trading partners. Additionally, the work group will facilitate the
implementation and education of the standards and process.
During the February Work Group meetings, WG7 will hear updates from the following task
groups:
 Reference Guide Task Group
 Medicaid Drug Rebate Program Task Group
 Medical Rebate Task Group
 Manufacturer Rebate Standard Update Task Group
o Specialty Pharmacy Data Exchange Sub-Task Group
 Regulatory Tracking/Pedigree Task Group
 Formulary Management Survey Task Group
WG7 will also hear an update from WG9’s OIG Report OEI-05-12-00540 Task Group.
Documents for discussion that are available on the WG7 page include:
 201502.WG7.zip containing
o Agenda
o Task Group Recaps
 See web page for all available documentation
WG9 Government Programs
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Work Group 9 Government Programs, in conjunction with Work Group 1 Telecommunication,
guides and advises Federal and State funded pharmacy programs and their agents on standards
implementation, supports data processing initiatives, and provides design alternatives for
standards, which support government requirements.
During the February Work Group meetings WG9 will hear updates from the following task
groups:
 Prescription Monitoring Programs Task Group
 340B Task Group
 Medicare Part D FAQ Task Group
 Medicare Part B Claim Billing for Dual Eligibles
 Medicaid Subrogation FAQ Task Group
 Supplemental Payer Part D Reconciliation Task Group
 Health Insurance Exchange/Marketplace Task Group
 Hospice Task Group
 Standardized Fraud, Waste and Abuse Training Attestation Task Group
 OIG Report OEI-05-12-00540 Task Group
WG9 will also:
 Receive a Legislative/Government Programs Update
 Receive an update from WG1 Subrogation Task Group
Documents for discussion that are available on the WG9 page include:
 201502.WG9.zip containing
o Agenda
o Task Group Recaps
 See web page for all available documentation
WG10 Professional Pharmacy Services
Work Group 10 Professional Pharmacy Services assists in the development and maintenance of
standards to support electronic documentation and transmission of data for professional
pharmacy services.
WG10 will review DERF 001236 Revising the MTM sections of the Specialized Implementation
Guide. WG10 will hear updates from the following task groups:
 MTM Communication Task Group
 Acetaminophen Best Practices Task Group
 WG1-10 Compound Billing Solutions Task Group
 WG11 Specialty Requirements- eRx Task Group
 WG7 Specialty Reporting to Manufacturers Task Group
WG10 will have two guest presentations
 Lynnae M. Mahaney, Executive Director, Center for Pharmacy Practice Accreditation:
Pharmacy Certification
• Jami Earnest, Senior Scientific Liaison, Healthcare Quality Standards, United States
Pharmacopeia: USP role in the Allergy Project
Documents for discussion that are available on the WG10 page include:
 201502.WG10.zip containing
o Agenda
o Task Group Recaps
o Presentations
 See web page for all available documentation
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WG11 ePrescribing & Related Transactions
Work Group 11 ePrescribing & Related Transactions develops standardized messages for
prescribers, pharmacists, payers and/or other interested parties to exchange information.
During the February Work Group meetings, WG11 will hear updates from the following task
groups:
 WG14/11 LTCPAC ePrescribing Task Group
 Formulary and Benefit Task Group
 XML Task Group
 NCPDP/HL7 Pharmacist Functional Profile Task Group
 ePrescribing Best Practices Task Group
 REMS and ePrescribing Task Group
 WG2/11 Joint Drug Description Task Group
 Electronic Prior Authorization Workflow to Transactions Task Group
 Meaningful Use and NIST Test Methods for ePrescribing Task Group
 Implementation of Structured Sig Task Group
 Specialty Requirements for ePrescribing Task Group
WG11 will:
 Review comments on Ballot WG110062R
 Receive a status on industry activities
 Discuss questions and answers for inclusion in the SCRIPT Implementation
Recommendations document
 Discuss questions and answers for inclusion in the Formulary and Benefit
Implementation Recommendations document (if applicable)
 Receive report on the review of content from the SCRIPT Implementation
Recommendation for inclusion in the next version of SCRIPT Implementation Guide
Documents for discussion that are available on the WG11 page include:
 201502.WG11.zip containing:
o Agenda
o Task Group Recaps
o DSMO Change Requests (if applicable)
 Next version of SCRIPT documents – Changes since 10.6 and Timeframe Considerations.
See web page for all available documentation
WG14 Long Term and Post Acute Care (LTPAC)
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.
During the February Work Group meetings, WG14 will hear a status from the following task
groups:
 Current Billing Issues Task Group
 ePrescribing Task Group
WG14 will also:
 Receive an update from the WG9 Hospice Task Group and WG9 Medicare Part D FAQ
Task Group
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
Discuss Industry/Regulatory Updates
Documents for discussion that are on the WG14 web page include:
 201502.WG14.zip containing
o Agenda
o Task Group Recaps
 See web page for all available documentation.
WG16 Property and Casualty/Workers’ Compensation
Work Group 16 Property and Casualty/Workers' Compensation will ascertain, monitor and
analyze regulatory requirements to develop 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 (including but not limited to uniform billing, state
reporting policies and the overall delivery of pharmacy services/care.)
WG 16 will receive status reports from the following task groups:
 Legislative/Regulatory Monitoring and Education Task Group
 Billing and State Reporting Task Group
WG16 will:
 Receive an update on IAIABC
Documents for discussion that are on the WG16 web page include:
 201502.WG16.zip containing
o Agenda
o Task Group Recaps
 See web page for all available documentation.
WG45 External Standards Assessment, Harmonization and Implementation Guidance
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, the ASC X12N Implementation Guides and the Health Level Seven International (HL7)
Standards.
 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.
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During the February Work Group meetings, WG45 will hear updates from the following task
groups:
 Document Revision Task Group
 834/835 FAQ Task Group
 DSMO Change Request Task Group
 CAQH CORE Task Group
WG45 will receive the following reports:
 Industry Updates (WEDI, NCPDP SNIP, X12, HIPAA, CAQH CORE)
 Inter-SDO Process
 Legislation Work Group
Documents available on the WG45 web page include:
 201502.WG16.zip containing
o Agenda
o Task Group Recaps
 See web page for all available documentation.
MC Maintenance and Control:
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.
During the February Work Group meetings, MC will hear a status from the following task groups:
 PDMP White Paper Task Group
 NDC Scarcity Task Group
 Education/Legislation Task Group
 Real-Time Prescription Benefit Inquiry Task Group
 Unique Device Identifier (UDI) Task Group
 Sig in Transactions
MC will also:
 Review new and pended DERFs
 Review New Project Development Form
 Receive daily WG updates
 Receive updates on HIPAA
 Receive a Legislative/Regulatory update
Documents for discussion that are on the MC page include:
 201502.MC.zip containing
o Agenda
o Data Element Request Forms (DERFs)
o Task Group Recaps
 See web page for all available documentation
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