Standards Matrix - NCPDP
Standards Matrix
October 2023 National Council for Prescription Drug Programs 9240 East Raintree Drive Scottsdale, AZ 85260 Phone: (480) 477-1000 Fax: (480) 767-1042 email: ncpdp@
Standards Matrix
Standards Matrix
Published by: National Council for Prescription Drug Programs This work is owned by National Council for Prescription Drug Programs, Inc., 9240 E. Raintree Drive, Scottsdale, AZ 85260, (480) 477-1000, ncpdp@, and protected by the copyright laws of the United States. 17 U.S.C. ?101, et. seq. Permission is given to Council members to copy and use the work or any part thereof in connection with the business purposes of the Council members. The work may not be changed or altered. The work may not be sold, used or exploited for commercial purposes. This permission may be revoked by National Council for Prescription Drug Programs, Inc., at any time. The National Council for Prescription Drugs Programs, Inc. is not responsible for any errors or damage as a result of the use of the work.
Copyright ? 2023 NCPDP
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Standards Matrix
TABLE OF CONTENTS
STANDARDS MATRIX .................................................................................................................................................................................................. 5
VERSION IDENTIFICATION SYSTEM ......................................................................................................................................................................... 6
AUDIT TRANSACTION STANDARD IMPLEMENTATION GUIDE.............................................................................................................................. 8
BATCH STANDARD IMPLEMENTATION GUIDE ..................................................................................................................................................... 10
BATCH STANDARD SUBROGATION IMPLEMENTATION GUIDE ......................................................................................................................... 12
BENEFIT INTEGRATION STANDARD IMPLEMENTATION GUIDE......................................................................................................................... 13
EXAMPLES GUIDE ....................................................................................................................................................................................................... 13
BILLING UNIT STANDARD IMPLEMENTATION GUIDE .......................................................................................................................................... 17
COMMENTS ONLY ON STANDARDS FROM OTHER ACCREDITED STANDARDS DEVELOPERS (ASD) ........................................................ 19
HL7? FHIR? SPECIALTY MEDICATION ENROLLMENT IMPLEMENTATION GUIDE ............................................................................................................. 19 X12 852 PRODUCT ACTIVITY REPORT SPECIFICATION.................................................................................................................................................. 19 HL7? CDA PHARMACIST CARE PLAN.......................................................................................................................................................................... 19 HL7? FHIR? PHARMACIST CONSULTATION NOTE ....................................................................................................................................................... 20
DATA DICTIONARY .................................................................................................................................................................................................... 20
EXTERNAL CODE LIST (ECL) ................................................................................................................................................................................... 21
EMERGENCY TELECOMMUNICATION EXTERNAL CODE LIST VALUE ADDENDUM............................................................................................................... 29 SCRIPT AND SPECIALIZED EXPEDITED EXTERNAL CODE LIST XML ADDENDUM ............................................................................................................ 30
FINANCIAL INFORMATION REPORTING STANDARD IMPLEMENTATION GUIDE ............................................................................................. 30
FINANCIAL INFORMATION REPORTING EDITORIAL DOCUMENT........................................................................................................................................ 31
FORMULARY AND BENEFIT STANDARD IMPLEMENTATION GUIDE ................................................................................................................. 32
FUNCTIONAL PROFILES FOR ELECTRONIC HEALTH RECORD (EHR) SYSTEMS ............................................................................................ 34
MANUFACTURER REBATE, UTILIZATION, PLAN, FORMULARY, MARKET BASKET, AND RECONCILIATION FLAT FILE STANDARD AND IMPLEMENTATION GUIDE ........................................................................................................................................................................................ 35
MEDICAID PHARMACY ENCOUNTERS REPORTING STANDARD IMPLEMENTATION GUIDE ......................................................................... 40
MEDICAID SUBROGATION IMPLEMENTATION GUIDE ......................................................................................................................................... 41
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Standards Matrix
MEDICAID SUBROGATION VERSION 3.0 QUESTIONS, ANSWERS AND EDITORIAL UPDATES .............................................................................................. 41
MEDICAL REBATE DATA SUBMISSION STANDARD IMPLEMENTATION GUIDE............................................................................................... 42
NCPDP XML SCHEMAS ............................................................................................................................................................................................. 43
OPERATING RULES................................................................................................................................................................................................... 44
OPERATING RULES FOR THE X12 270/271 TRANSACTIONS IN ELECTRONIC PRESCRIBING.............................................................................................. 44 OPERATING RULES FOR CONNECTIVITY ....................................................................................................................................................................... 44 OPERATING RULES FOR THE FORMULARY AND BENEFIT STANDARD .......................................................................................................................................... 44
PHARMACY AND/OR COMBINATION ID CARD IMPLEMENTATION GUIDE ........................................................................................................ 46
POST ADJUDICATION STANDARD IMPLEMENTATION GUIDE ............................................................................................................................ 47
PRESCRIPTION DRUG MONITORING PROGRAMS (PDMP) STANDARD IMPLEMENTATION GUIDE .............................................................. 49
PRESCRIPTION TRANSFER STANDARD IMPLEMENTATION GUIDE .................................................................................................................. 50
PRIOR AUTHORIZATION TRANSFER STANDARD IMPLEMENTATION GUIDE ................................................................................................... 51
PRODUCT IDENTIFIERS STANDARD IMPLEMENTATION GUIDE......................................................................................................................... 52
REAL-TIME PRESCRIPTION BENEFIT STANDARD IMPLEMENTATION GUIDE.................................................................................................. 53
REAL-TIME PRESCRIPTION BENEFIT (RTPB) IMPLEMENTATION RECOMMENDATIONS...................................................................................................... 53 EXAMPLES GUIDE ....................................................................................................................................................................................................... 53
RETIREE DRUG SUBSIDY STANDARD IMPLEMENTATION GUIDE...................................................................................................................... 59
SCRIPT STANDARD IMPLEMENTATION GUIDE..................................................................................................................................................... 60
SCRIPT IMPLEMENTATION RECOMMENDATIONS .......................................................................................................................................................... 60 EXAMPLES GUIDE ....................................................................................................................................................................................................... 60
SIGNATURE LOG ....................................................................................................................................................................................................... 85
SPECIALIZED STANDARD IMPLEMENTATION GUIDE .......................................................................................................................................... 86
EXAMPLES GUIDE ....................................................................................................................................................................................................... 86
SPECIALTY PHARMACY DATA REPORTING STANDARD IMPLEMENTATION GUIDE ...................................................................................... 98
STATE MEDICAID PROVIDER FILE STANDARD IMPLEMENTATION GUIDE ...................................................................................................... 99
STRUCTURED AND CODIFIED SIG FORMAT........................................................................................................................................................ 100
TELECOMMUNICATION STANDARD IMPLEMENTATION GUIDE ....................................................................................................................... 101
TELECOMMUNICATION VERSION D AND ABOVE QUESTIONS, ANSWERS AND EDITORIAL UPDATES ................................................................................. 101
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Standards Matrix
NCPDP EMERGENCY PREPAREDNESS ...................................................................................................................................................................... 102 EXAMPLES GUIDE ..................................................................................................................................................................................................... 102
UNIFORM HEALTHCARE PAYER DATA STANDARD IMPLEMENTATION GUIDE............................................................................................. 114
UNIVERSAL CLAIM FORM ...................................................................................................................................................................................... 116
MANUAL CLAIM FORMS REFERENCE .......................................................................................................................................................................... 116 UNIVERSAL CLAIM FORM PURCHASE ......................................................................................................................................................................... 116
XML STANDARD ...................................................................................................................................................................................................... 118
APPENDIX A. STANDARDS/GUIDES/FORMATS NO LONGER MAINTAINED OR SUPPORTED ...................................................................... 121
NCPDP OPERATING RULES FOR THE X12 835 TRANSACTION AND EFT IN PHARMACY INDUSTRY ................................................................................ 121 COMPOUND TRANSACTION IMPLEMENTATION GUIDE................................................................................................................................................... 121 DISKETTE STANDARD FORMAT .................................................................................................................................................................................. 121 MEMBER ENROLLMENT STANDARD AND IMPLEMENTATION GUIDE ................................................................................................................................ 121 ORDUR APPLICATION MANUAL................................................................................................................................................................................. 122 PAYMENT RECONCILIATION PAYMENT TAPE FORMAT.................................................................................................................................................. 122 PRIOR AUTHORIZATION IMPLEMENTATION GUIDE ........................................................................................................................................................ 122 PROFESSIONAL PHARMACY SERVICES (PPS) IMPLEMENTATION GUIDE ....................................................................................................................... 123 NCPDP-HL7 ELECTRONIC PRESCRIBING COORDINATION .......................................................................................................................................... 123
Standards Matrix
The mission of NCPDP is clear: to create and promote data interchange standards for the pharmacy services sector of the health care industry, and to provide information and resources that educate the industry and support the diverse needs of our members. As needs within the industry are identified, standards are updated to a new version or release. The following is a high-level overview of the latest version/release and/or the most commonly used of those standards and implementation guides, as well as NCPDP's Data Dictionary and External Code List. Additionally, this document provides version/release/publication reference charts for approved and draft NCPDP standards/implementation guides.
Legend for the reference charts: Column 1 Contains the Name of the Standard or Implementation Guide document.
Ballot Info Contains the ballot period and ballot number in which the Standard or Implementation Guide appeared for review by the NCPDP membership and materially affected parties.
"DRAFT" October 2023
National Council for Prescription Drug Programs, Inc.
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