AETNA NCPDP D.Ø CLAIM BILLING (B1) MEDICARE PAYER SHEET IMPLEMENTATION GUIDE FOR VERSION D.Ø VERSION 4.Ø
|
|
- Annabelle Marshall
- 6 years ago
- Views:
Transcription
1 AETNA NCPDP D.Ø CLAI BILLING (B1) EDICAE PAYE SHEET IPLEENTATION GUIDE FO VESION D.Ø VESION 4.Ø October 2012
2 TABLE OF CONTENTS 1. NCPDP VESION D CLAI BILLING EDICAE EQUEST CLAI BILLING EDICAE PAYE SHEET ESPONSE CLAI BILLING EDICAE PAYE SHEET edicare Accepted/Paid (or Duplicate of Paid) esponse edicare Accepted/ejected esponse edicare ejected/ejected esponse FEQUENTLY ASKED QUESTIONS APPENDI A. HISTOY OF IPLEENTATION GUIDE CHANGES VESION 1.Ø VESION 2.Ø VESION 3.Ø VESION 4.Ø
3 1. NCPDP VESION D CLAI BILLING EDICAE 1.1 EQUEST CLAI BILLING EDICAE PAYE SHEET ** Start of equest (B1) Payer Sheet ** GENEAL INFOATION Payer Name: Aetna Date: October 2012 Plan Name/Group Name: edicare Part D BIN: 61Ø5Ø2 PCN: EDDAET Plan Name/Group Name: edicare Advantage Part D BIN: 61Ø5Ø2 PCN: EDDAET Plan Name/Group Name: edicare Advantage Only (Part B Only) BIN: 61Ø5Ø2 PCN: PATBAET Processor: Aetna Pharmacy anagement Effective as of: 1/1/2013 NCPDP Telecommunication Standard Version/elease #: D.Ø NCPDP Data Dictionary Version Date: October 2011 NCPDP External Code List Version Date: October 2011 Contact/Information Source: NCPDPD.0Questions@aetna.com Provider elations Help Desk Info: 8ØØ OTHE TANSACTIONS SUPPOTED Transaction Code B2 Transaction Name Billing eversal FIELD LEGEND FO COLUNS Payer Column Value Explanation Column ANDATOY The Field is mandatory for the Segment in the designated Transaction. No EQUIED The Field has been designated with the situation No of "equired" for the Segment in the designated Transaction. QUALIFIED EQUIEENT equired when. The situations designated have Yes qualifications for usage ("equired if x", "Not required if y"). NOT USED NA The field is not used. Do not submit. No OPTIONAL O The field is optional. Yes Fields that are defined as NOT USED in the D.Ø implementation guide should not be submitted. If a field that is defined as NOT USED is submitted, the transaction will be rejected. Fields that are defined as Optional in the D.Ø Implementation guide are not required for Aetna Processing however if they are submitted they must conform to NCPDP format. All Character fields will be checked for length limitations and the exceeding characters will be truncated. Example: A field can hold 2 Chars. If the value received for the field is ABC, the value will be truncated to 2 Chars and send AB. NOTE: Aetna only supports B1 and B2 Transactions
4 CLAI BILLING TANSACTION The following lists the segments and fields in a Transaction for the NCPDP Telecommunication Standard Implementation Guide Version D.Ø. Transaction Header Segment Questions Check Source of certification IDs required in Software Vendor/Certification ID (11Ø-AK) is Payer Issued Source of certification IDs required in Software Vendor/Certification ID (11Ø-AK) is Switch/VAN issued Source of certification IDs required in Software Vendor/Certification ID (11Ø-AK) is Not used Transaction Header Segment 1Ø1-A1 BIN NUBE 61Ø5Ø2 1Ø2-A2 VESION/ELEASE NUBE DØ 1Ø3-A3 TANSACTION CODE B1 1Ø4-A4 POCESSO CONTOL NUBE EDDAET PATBAET 1Ø9-A9 TANSACTION COUNT 1 PDP/APD = EDDAET A Only = PATBAET 1=One Occurrence 2Ø2-B2 SEVICE POVIDE ID QUALIFIE Ø1 Ø1 = NPI 2Ø1-B1 SEVICE POVIDE ID NPI 4Ø1-D1 DATE OF SEVICE 11Ø-AK SOFTWAE VENDO/CETIFICATION ID Insurance Segment Questions Check Insurance Segment Segment Identification (111-A) = Ø4 3Ø2-C2 CADHOLDE ID 336-8C FACILITY ID NA 3Ø1-C1 GOUP ID The Group number from the member's ID card must be entered exactly as written on the card, excluding dashes and spaces. 3Ø3-C3 PESON CODE 3Ø6-C6 PATIENT ELATIONSHIP CODE Patient Segment Questions Check This Segment is situational Patient Segment Segment Identification (111-A) = Ø1 Field NCPDP Field Name Value Payer 3Ø4-C4 DATE OF BITH 3Ø5-C5 PATIENT GENDE CODE 31Ø-CA PATIENT FIST NAE 311-CB PATIENT LAST NAE 334-1C SOKE/NON-SOKE CODE NA - 4 -
5 Patient Segment Segment Identification (111-A) = Ø1 Field NCPDP Field Name Value Payer PATIENT ESIDENCE 0, 1, 3, 4, 6, 9, 11, 15 0=Not Specified 1=Home 3=Nursing Facility 4=Assisted Living Facility 6= Group Home 9= Intermediate care facilities for the mentally retarded (ICF/) and Institutes for mental disease (ID) 11=Hospice 15=Correctional Institution Claim Segment Questions Check This payer supports partial fills This payer does not support partial fills Claim Segment Segment Identification (111-A) = Ø7 455-E PESCIPTION/SEVICE EFEENCE 1 = x Billing NUBE QUALIFIE 4Ø2-D2 PESCIPTION/SEVICE EFEENCE NUBE 436-E1 PODUCT/SEVICE ID QUALIFIE ØØ, Ø3 ØØ-Not Specified Ø3-National Drug Code (NDC) Use ØØ when Compound Code (4Ø6-D6) = 2 Use Ø3 when Compound Code (4Ø6-D6) = 1 4Ø7-D7 PODUCT/SEVICE ID Use Ø when Compound Code (4Ø6-D6) = E7 QUANTITY DISPENSED ust be greater than zero 4Ø3-D3 FILL NUBE Ø - Original dispensing efill number 4Ø5-D5 DAYS SUPPLY 4Ø6-D6 COPOUND CODE 1, 2 1 = Not a Compound 2 = Compound 4Ø8-D8 DISPENSE AS WITTEN Ø - No Product Selection (DAW)/PODUCT SELECTION CODE Indicated 1 - Substitution Not Allowed by Prescriber 2 - Substitution Allowed-Patient equested Product Dispensed 3 - Substitution Allowed- Pharmacist Selected Product Dispensed 4 - Substitution Allowed-Generic Drug Not in Stock 5 - Substitution Allowed-Brand Drug Dispensed as a Generic 6 - Override 7 - Substitution Not Allowed-Brand Drug andated by Law 8 - Substitution Allowed-Generic Drug Not Available in arketplace 9 - Substitution Allowed By Prescriber but Plan equests Brand 414-DE DATE PESCIPTION WITTEN When claim is for a ulti-source Brand the Dispense As Written cannot be Ø. If the DAW submitted is Ø the claim will reject
6 Claim Segment Segment Identification (111-A) = Ø7 419-DJ PESCIPTION OIGIN CODE Ø N SUBISSION CLAIFICATION CODE COUNT Ø - Not Known 1 - Written 2 - Telephone 3 - Electronic 4 - Facsimile 1, 2 or 3 equired if Submission Clarification Code (42Ø-DK) is used. 42Ø-DK SUBISSION CLAIFICATION CODE 3, 4, 5, 7, 8, 13, 19, 21 36, Vacation Supply 4 - Lost Prescription 5 - Therapy Change 7 - edically Necessary 8 - Process Compound For Approved Ingredients 13 - Payer-ecognized Emergency/Disaster Assistance equest 19-Split Billing 21- LTC Dispensing: 14 days or less not applicable 22- LTC Dispensing: 7 days 23- LTC Dispensing: 4 days 24- LTC Dispensing: 3 days 25- LTC Dispensing : 2 days 26- LTC Dispensing: 1 day 27- LTC Dispensing: 4-3 days 28- LTC Dispensing: days 29- LTC Dispensing: daily and 3- day weekend 30- LTC Dispensing: Per shift dispensing 31-LTC Dispensing: Per med pass dispensing 32- LTC Dispensing: PN on demand 33- LTC Dispensing: 7 day or less dispensing method not listed above 34- LTC Dispensing: 14 day or less 35- LTC Dispensing: 8-14 day dispensing method not listed above 36- LTC Dispensing: dispensed outside short cycle 42 - Prescriber ID Submitted has been validated, is active 46Ø-ET QUANTITY PESCIBED NA 3Ø8-C8 OTHE COVEAGE CODE Ø - Not Specified by patient 1 - No other coverage equired when pharmacist approves to process Compound for approved ingredients only or when submitting for LTC Short Cycle Dispening or when submitting a split billing claim from a LTC or to override rejected claims due to a DU threshold being met. See COB Payer Sheet for COB values. 418-DI LEVEL OF SEVICE 3 - Emergency equired when filling an emergency prescription. 88Ø-K5 TANSACTION EFEENCE NUBE NA 995-E2 OUTE OF ADINISTATION O 996-G1 COPOUND TYPE equired when Compound Code (4Ø6-D6) = U7 PHAACY SEVICE TYPE 1 8, 99 1=Community//etail Pharmacy Services - 6 -
7 Claim Segment Segment Identification (111-A) = Ø7 2=Compounding Pharmacy Services 3=Home Infusion Therapy Provider Services 4=Institutional Pharmacy Services 5=Long Term Care Pharmacy Services 6=ail Order Pharmacy Services 7=anaged Care Organization Pharmacy Services 8=Specialty Care Pharmacy Services 99=Other 429-DT SPECIAL PACKAGING INDICATO 0-8 equired for LTC Short Cycle Dispensing 0- Not Specified 1- Not Unit Dose 2- anufacturer Unit Does 3- Pharmacy Unit Does 4- Pharmacy Unit Does Patient Compliance Packaging 5- Pharmacy ulti-drug Patient Compliance Packaging 6- emote device unit does 7- emote device ulti-drug compliance 8- anufacturer unit of use packaging Pricing Segment Questions Check Pricing Segment Segment Identification (111-A) = 11 4Ø9-D9 INGEDIENT COST SUBITTED 412-DC DISPENSING FEE SUBITTED 477-BE POFESSIONAL SEVICE FEE NA SUBITTED 438-E3 INCENTIVE AOUNT SUBITTED equired if its value has an effect on the Gross Amount Due (43Ø-DU) calculation. 478-H7 OTHE AOUNT CLAIED SUBITTED COUNT equired when for edicare Part D Vaccine Administration Fee. Valid values - Ø, 1, 2, 3 equired if Other Amount Claimed Submitted Qualifier (479-H8) is used. 479-H8 OTHE AOUNT CLAIED SUBITTED QUALIFIE Valid values - Ø1 to Ø4, 99 equired when Other Amount Claimed Submitted Qualifier and Other Amount Claimed Submitted Amount are used. equired if Other Amount Claimed Submitted (48Ø-H9) is used. (Blank is not allowed) Ø1 - Delivery Cost Ø2 - Shipping Cost Ø3 - Postage Cost Ø4 - Administrative Cost 99 - Other equired when Other Amount Claimed Submitted Count and Other Amount Claimed Submitted Amount are used. 48Ø-H9 OTHE AOUNT CLAIED SUBITTED equired if its value has an effect on the Gross
8 Pricing Segment Segment Identification (111-A) = 11 Amount Due (43Ø-DU) calculation. equired when Other Amount Claimed Submitted Count and Other Amount Claimed Submitted Qualifier are used. 481-HA FLAT SALES TA AOUNT SUBITTED equired if its value has an effect on the Gross Amount Due (43Ø-DU) calculation. 482-GE PECENTAGE SALES TA AOUNT SUBITTED equired if its value has an effect on the Gross Amount Due (43Ø-DU) calculation. equired when Percentage Sales Tax ate Submitted and Percentage Sales Tax Basis Submitted are used. equired when percentage sales tax applies to the claim for states with sales tax. 483-HE PECENTAGE SALES TA ATE SUBITTED Note: This currently applies to the following states: IL, and LA (for non-part D drugs) equired when Percentage Sales Tax ate Submitted and Percentage Sales Tax Basis Submitted are used. 484-JE PECENTAGE SALES TA BASIS SUBITTED Ø2, Ø3 Ø2 - Ingredient Cost Ø3 - Ingredient Cost + Dispensing Fee equired if Percentage Sales Tax Amount Submitted (482-GE) and Percentage Sales Tax ate Submitted (483-HE) are used. 426-DQ USUAL AND CUSTOAY CHAGE 43Ø-DU GOSS AOUNT DUE Value in this field must balance with all submitted amount fields. 423-DN BASIS OF COST DETEINATION Ø1-13 Ø1 - AWP (Average Wholesale Price) Ø2 - Local Wholesaler Ø3 - Direct Ø4 - EAC (Estimated Acquisition Cost) Ø5 - Acquisition Ø6 - AC (aximum Allowable Cost) Ø7 - Usual & Customary Ø8-34ØB / Disproportionate Share Pricing/Public Health Service Ø9 - Other 1Ø - ASP (Average Sales Price) 11 - AP (Average anufacturer Price) 12 - WAC (Wholesale Acquisition Cost) 13 - Special Patient Pricing The cost calculated by the pharmacy for the drug for this special patient
9 Prescriber Segment Questions Check This Segment is situational Prescriber Segment Segment Identification (111-A) = Ø3 466-EZ PESCIBE ID QUALIFIE Ø1 Ø1=National Provider Identifier (NPI) 411-DB PESCIBE ID 467-1E PESCIBE LOCATION CODE NA DU/PPS Segment Questions Check This Segment is situational DU/PPS Segment Segment Identification (111-A) = Ø E DU/PPS CODE COUNTE aximum of 9 occurrences. equired if DU/PPS Segment is used. 439-E4 EASON FO SEVICE CODE equired when used for DU conflict resolution (drug/drug interactions or therapeutic duplication) 44Ø-E5 POFESSIONAL SEVICE CODE equired when used for DU conflict resolution Use value A when billing for edicare Part D Vaccine Administration Fee. 441-E6 ESULT OF SEVICE CODE equired when used for DU conflict resolution 474-8E DU/PPS LEVEL OF EFFOT Ø, equired when Compound Code (4Ø6-D6) = 2 Ø - Not Specified 11 - Level 1 (Lowest) 12 - Level Level Level Level 5 (Highest) Coupon Segment Questions Check This Segment is situational Coupon Segment Segment Identification (111-A) = Ø9 485-KE COUPON TYPE 486-E COUPON NUBE Compound Segment Questions Check This Segment is situational Compound Segment Segment Identification (111-A) = 1Ø - 9 -
10 45Ø-EF COPOUND DOSAGE FO DESCIPTION CODE 451-EG COPOUND DISPENSING UNIT FO INDICATO 447-EC COPOUND INGEDIENT COPONENT aximum 25 ingredients COUNT 488-E COPOUND PODUCT ID QUALIFIE Ø3-National Drug Code (NDC) 489-TE COPOUND PODUCT ID 448-ED COPOUND INGEDIENT QUANTITY ust be greater than zero. 449-EE COPOUND INGEDIENT DUG COST ust be greater than zero. 49Ø-UE COPOUND INGEDIENT BASIS OF COST DETEINATION Ø1 - AWP (Average Wholesale Price) Ø2 - Local Wholesaler Ø3 - Direct Ø4 - EAC (Estimated Acquisition Cost) Ø5 - Acquisition Ø6 - AC (aximum Allowable Cost) Ø7 - Usual & Customary Ø8-34ØB /Disproportionate Share Pricing/Public Health Service Ø9 - Other 1Ø - ASP (Average Sales Price) 11 - AP (Average anufacturer Price) 12 - WAC (Wholesale Acquisition Cost) 13 - Special Patient Pricing The cost calculated by the pharmacy for the drug for this special patient. Clinical Segment Questions Check This Segment is situational Clinical Segment Segment Identification (111-A) = VE DIAGNOSIS CODE COUNT 492-WE DIAGNOSIS CODE QUALIFIE 424-DO DIAGNOSIS CODE O 493-E CLINICAL INFOATION COUNTE O 494-ZE EASUEENT DATE O 495-H1 EASUEENT TIE O 496-H2 EASUEENT DIENSION O 497-H3 EASUEENT UNIT O 499-H4 EASUEENT VALUE O ** End of equest (B1) Payer Sheet **
11 1.2 ESPONSE CLAI BILLING EDICAE PAYE SHEET CLAI BILLING EDICAE ACCEPTED/PAID (O DUPLICATE OF PAID) ESPONSE ** Start of esponse (B1) Payer Sheet ** GENEAL INFOATION Payer Name: Aetna Date: July 2Ø12 Plan Name/Group Name: edicare Part D BIN: 61Ø5Ø2 PCN: EDDAET Plan Name/Group Name: edicare Advantage Part D BIN: 61Ø5Ø2 PCN: EDDAET Plan Name/Group Name: edicare Advantage Only (Part B Only) BIN: 61Ø5Ø2 PCN: PATBAET CLAI BILLING PAID (O DUPLICATE OF PAID) ESPONSE The following lists the segments and fields in a response (Paid or Duplicate of Paid) Transaction for the NCPDP Telecommunication Standard Implementation Guide Version D.Ø. esponse Transaction Header Segment Questions Check Accepted/Paid (or Duplicate of Paid) esponse Transaction Header Segment 1Ø2-A2 VESION/ELEASE NUBE DØ 1Ø3-A3 TANSACTION CODE B1 1Ø9-A9 TANSACTION COUNT Same value as in request 5Ø1-F1 HEADE ESPONSE STATUS A = Accepted 2Ø2-B2 SEVICE POVIDE ID QUALIFIE Same value as in request 2Ø1-B1 SEVICE POVIDE ID Same value as in request 4Ø1-D1 DATE OF SEVICE Same value as in request Accepted/Paid (or Duplicate of Paid) esponse essage Segment Questions Check Accepted/Paid (or Duplicate of Paid) This Segment is situational If transmission level messaging applies. esponse essage Segment Segment Identification (111-A) = 2Ø 5Ø4-F4 ESSAGE O Accepted/Paid (or Duplicate of Paid) esponse Insurance Segment Questions Check Accepted/Paid (or Duplicate of Paid) This Segment is situational esponse Insurance Segment Segment Identification (111-A) = 25 Accepted/Paid (or Duplicate of Paid) 3Ø1-C1 GOUP ID 524-FO PLAN ID O Will send back if available
12 esponse Insurance Segment Segment Identification (111-A) = J7 PAYE ID QUALIFIE Ø3 Accepted/Paid (or Duplicate of Paid) Ø3 = Bank Identification Number (BIN) 569-J8 PAYE ID 61Ø5Ø2 3Ø2-C2 CADHOLDE ID O Will Send back the ID that is used in Adjudication, only if different than what was submitted on request. esponse Patient Segment Questions Check Accepted/Paid (or Duplicate of Paid) This Segment is situational When the submitted Patient First Name and/or Last Name are different than what is on the member record. esponse Patient Segment Segment Identification (111-A) = 29 31Ø-CA PATIENT FIST NAE 311-CB PATIENT LAST NAE 3Ø4-C4 DATE OF BITH Accepted/Paid (or Duplicate of Paid) esponse Status Segment Questions Check Accepted/Paid (or Duplicate of Paid) esponse Status Segment Segment Identification (111-A) = AN TANSACTION ESPONSE STATUS P=Paid D=Duplicate of Paid 5Ø3-F3 AUTHOIZATION NUBE Accepted/Paid (or Duplicate of Paid) 13Ø-UF ADDITIONAL ESSAGE INFOATION COUNT aximum count of 9. equired if Additional essage Information (526-FQ) is used. 132-UH ADDITIONAL ESSAGE INFOATION QUALIFIE equired if Additional essage Information (526-FQ) is used. 526-FQ ADDITIONAL ESSAGE INFOATION equired when additional text is needed for clarification or detail. 131-UG ADDITIONAL ESSAGE INFOATION CONTINUITY equired if and only if current repetition of Additional essage Information (526-FQ) is used, another populated repetition of Additional essage Information (526-FQ) follows it, and the text of the following message is a continuation of the current F HELP DESK PHONE NUBE Ø3 QUALIFIE 55Ø-8F HELP DESK PHONE NUBE 8ØØ
13 esponse Claim Segment Questions Check Accepted/Paid (or Duplicate of Paid) esponse Claim Segment Segment Identification (111-A) = E PESCIPTION/SEVICE EFEENCE NUBE QUALIFIE 4Ø2-D2 PESCIPTION/SEVICE EFEENCE NUBE Accepted/Paid (or Duplicate of Paid) 1 = xbilling Imp Guide: For Transaction Code of B1, in the esponse Claim Segment, the Prescription/Service eference Number Qualifier (455-E) is 1 (x Billing). esponse Pricing Segment Questions Check Accepted/Paid (or Duplicate of Paid) esponse Pricing Segment Segment Identification (111-A) = 23 Accepted/Paid (or Duplicate of Paid) 5Ø5-F5 PATIENT PAY AOUNT 5Ø6-F6 INGEDIENT COST PAID 5Ø7-F7 DISPENSING FEE PAID 558-AW FLAT SALES TA AOUNT PAID equired if Flat Sales Tax Amount Submitted (481-HA) is greater than zero (Ø) or if Flat Sales Tax Amount Paid (558-AW) is used to arrive at the final reimbursement. 559-A PECENTAGE SALES TA AOUNT PAID equired if Percentage Sales Tax Amount Submitted (482-GE) is greater than zero (Ø). equired if Percentage Sales Tax ate Paid (56Ø-AY) and Percentage Sales Tax Basis Paid (561-AZ) are used. 56Ø-AY PECENTAGE SALES TA ATE PAID equired if Percentage Sales Tax Amount Paid (559-A) is greater than zero (Ø). 561-AZ PECENTAGE SALES TA BASIS PAID equired if Percentage Sales Tax Amount Paid (559-A) is greater than zero (Ø). 521-FL INCENTIVE AOUNT PAID equired if Incentive Amount Submitted (438-E3) is greater than zero (Ø). 563-J2 OTHE AOUNT PAID COUNT aximum count of 3. equired if Other Amount Paid (565-J4) is used. 564-J3 OTHE AOUNT PAID QUALIFIE equired if Other Amount Paid (565-J4) is used. 565-J4 OTHE AOUNT PAID equired if Other Amount Claimed Submitted (48Ø-H9) is greater than zero (Ø). 5Ø9-F9 TOTAL AOUNT PAID 522-F BASIS OF EIBUSEENT DETEINATION 512-FC ACCUULATED DEDUCTIBLE AOUNT eturned if known or if applicable. 513-FD EAINING DEDUCTIBLE AOUNT eturned if known or if applicable. 514-FE EAINING BENEFIT AOUNT eturned if known or if applicable. 517-FH AOUNT APPLIED TO PEIODIC eturned if known and impacts Patient Pay DEDUCTIBLE 518-FI AOUNT OF COPAY eturned if known and impacts Patient Pay
14 esponse Pricing Segment Segment Identification (111-A) = 23 Accepted/Paid (or Duplicate of Paid) 52Ø-FK AOUNT ECEEDING PEIODIC eturned if known and impacts Patient Pay. BENEFIT AIU 572-4U AOUNT OF COINSUANCE eturned if known and impacts Patient Pay. 392-U BENEFIT STAGE COUNT equired if Benefit Stage Amount (394-W) is used. 393-V BENEFIT STAGE QUALIFIE equired if Benefit Stage Amount (394-W) is used. 394-W BENEFIT STAGE AOUNT equired when financial amounts are applied to edicare Part D beneficiary benefit stages. 129-UD HEALTH PLAN-FUNDED ASSISTANCE AOUNT eturned if known and impacts Patient Pay. 134-UK 137-UP AOUNT ATTIBUTED TO PODUCT SELECTION/BAND DUG AOUNT ATTIBUTED TO COVEAGE GAP eturned if known and impacts Patient Pay. eturned if known and impacts Patient Pay. esponse DU/PPS Segment Questions Check Accepted/Paid (or Duplicate of Paid) This Segment is situational If DU information applies. esponse DU/PPS Segment Segment Identification (111-A) = J6 DU/PPS ESPONSE CODE COUNTE aximum 9 occurrences supported. Accepted/Paid (or Duplicate of Paid) equired if eason For Service Code (439-E4) is used. 439-E4 EASON FO SEVICE CODE equired if utilization conflict is detected. 528-FS CLINICAL SIGNIFICANCE CODE equired if needed to supply additional information for the utilization conflict. 529-FT OTHE PHAACY INDICATO equired if needed to supply additional information for the utilization conflict. 53Ø-FU PEVIOUS DATE OF FILL equired if needed to supply additional information for the utilization conflict. 531-FV QUANTITY OF PEVIOUS FILL equired if needed to supply additional information for the utilization conflict. 532-FW DATABASE INDICATO equired if needed to supply additional information for the utilization conflict. 533-F OTHE PESCIBE INDICATO equired if needed to supply additional information for the utilization conflict. 544-FY DU FEE TET ESSAGE equired if needed to supply additional information for the utilization conflict. 57Ø-NS DU ADDITIONAL TET equired if needed to supply additional information for the utilization conflict
15 1.2.2 CLAI BILLING EDICAE ACCEPTED/EJECTED ESPONSE CLAI BILLING EDICAE ACCEPTED/EJECTED ESPONSE esponse Transaction Header Segment Questions Check Accepted/ejected esponse Transaction Header Segment 1Ø2-A2 VESION/ELEASE NUBE DØ 1Ø3-A3 TANSACTION CODE B1 1Ø9-A9 TANSACTION COUNT Same value as in request 5Ø1-F1 HEADE ESPONSE STATUS A = Accepted 2Ø2-B2 SEVICE POVIDE ID QUALIFIE Same value as in request 2Ø1-B1 SEVICE POVIDE ID Same value as in request 4Ø1-D1 DATE OF SEVICE Same value as in request Accepted/ejected esponse essage Segment Questions Check Accepted/ejected This Segment is situational If transmission level messaging applies. esponse essage Segment Segment Identification (111-A) = 2Ø 5Ø4-F4 ESSAGE O Accepted/ejected esponse Insurance Segment Questions Check Accepted/ejected This Segment is situational esponse Insurance Segment Accepted/ejected Segment Identification (111-A) = 25 3Ø1-C1 GOUP ID 524-FO PLAN ID O Will send back if available 568-J7 PAYE ID QUALIFIE Ø3 Ø3 = Bank Identification Number (BIN) 569-J8 PAYE ID 61Ø5Ø2 3Ø2-C2 CADHOLDE ID O Will Send back the ID that is used in Adjudication, only if different than what was submitted on request. esponse Patient Segment Questions Check Accepted/ejected This Segment is situational When the submitted Patient First Name and/or Last Name are different than is on the member record. esponse Patient Segment Segment Identification (111-A) = 29 31Ø-CA PATIENT FIST NAE Accepted/ejected 311-CB PATIENT LAST NAE 3Ø4-C4 DATE OF BITH
16 esponse Status Segment Questions Check Accepted/ejected esponse Status Segment Segment Identification (111-A) = AN TANSACTION ESPONSE STATUS = eject 5Ø3-F3 AUTHOIZATION NUBE 51Ø-FA EJECT COUNT aximum count of FB EJECT CODE 546-4F EJECT FIELD OCCUENCE INDICATO Accepted/ejected equired if a repeating field is in error, to identify repeating field occurrence. 13Ø-UF ADDITIONAL ESSAGE INFOATION COUNT aximum count of 9. equired if Additional essage Information (526-FQ) is used. 132-UH ADDITIONAL ESSAGE INFOATION QUALIFIE equired if Additional essage Information (526-FQ) is used. 526-FQ ADDITIONAL ESSAGE INFOATION equired when additional text is needed for clarification or detail. 131-UG ADDITIONAL ESSAGE INFOATION CONTINUITY equired if and only if current repetition of Additional essage Information (526-FQ) is used, another populated repetition of Additional essage Information (526-FQ) follows it, and the text of the following message is a continuation of the current F HELP DESK PHONE NUBE Ø3 QUALIFIE 55Ø-8F HELP DESK PHONE NUBE 8ØØ esponse Claim Segment Questions Check Accepted/ejected esponse Claim Segment Segment Identification (111-A) = E PESCIPTION/SEVICE EFEENCE 1 = xbilling NUBE QUALIFIE 4Ø2-D2 PESCIPTION/SEVICE EFEENCE NUBE Accepted/ejected esponse DU/PPS Segment Questions Check Accepted/ejected This Segment is situational If DU information applies. esponse DU/PPS Segment Accepted/ejected Segment Identification (111-A) = J6 DU/PPS ESPONSE CODE COUNTE aximum 9 occurrences. Imp Guide: equired if eason For Service Code (439-E4) is used. 439-E4 EASON FO SEVICE CODE Imp Guide: equired if utilization conflict is detected
17 esponse DU/PPS Segment Accepted/ejected Segment Identification (111-A) = FS CLINICAL SIGNIFICANCE CODE equired if needed to supply additional information for the utilization conflict 529-FT OTHE PHAACY INDICATO equired if needed to supply additional information for the utilization conflict 53Ø-FU PEVIOUS DATE OF FILL equired if needed to supply additional information for the utilization conflict 531-FV QUANTITY OF PEVIOUS FILL equired if needed to supply additional information for the utilization conflict 532-FW DATABASE INDICATO equired if needed to supply additional information for the utilization conflict 533-F OTHE PESCIBE INDICATO equired if needed to supply additional information for the utilization conflict 544-FY DU FEE TET ESSAGE equired if needed to supply additional information for the utilization conflict 57Ø-NS DU ADDITIONAL TET equired if needed to supply additional information for the utilization conflict CLAI BILLING EDICAE EJECTED/EJECTED ESPONSE CLAI BILLING EDICAE EJECTED/EJECTED ESPONSE esponse Transaction Header Segment Questions Check ejected/ejected esponse Transaction Header Segment 1Ø2-A2 VESION/ELEASE NUBE DØ 1Ø3-A3 TANSACTION CODE B1 1Ø9-A9 TANSACTION COUNT Same value as in request 5Ø1-F1 HEADE ESPONSE STATUS = ejected 2Ø2-B2 SEVICE POVIDE ID QUALIFIE Same value as in request 2Ø1-B1 SEVICE POVIDE ID Same value as in request 4Ø1-D1 DATE OF SEVICE Same value as in request ejected/ejected esponse essage Segment Questions Check ejected/ejected This Segment is situational If transmission level messaging applies. esponse essage Segment Segment Identification (111-A) = 2Ø 5Ø4-F4 ESSAGE O ejected/ejected esponse Status Segment Questions Check ejected/ejected esponse Status Segment Segment Identification (111-A) = AN TANSACTION ESPONSE STATUS = eject 5Ø3-F3 AUTHOIZATION NUBE 51Ø-FA EJECT COUNT aximum count of FB EJECT CODE 546-4F EJECT FIELD OCCUENCE INDICATO ejected/ejected Imp Guide: equired if a repeating field is in error, to identify repeating field occurrence
18 esponse Status Segment ejected/ejected Segment Identification (111-A) = 21 13Ø-UF ADDITIONAL ESSAGE INFOATION COUNT aximum count of 9. equired if Additional essage Information (526-FQ) is used 132-UH ADDITIONAL ESSAGE INFOATION QUALIFIE Imp Guide: equired if Additional essage Information (526-FQ) is used. 526-FQ ADDITIONAL ESSAGE INFOATION equired when additional text is needed for clarification or detail. 131-UG ADDITIONAL ESSAGE INFOATION CONTINUITY equired if and only if current repetition of Additional essage Information (526-FQ) is used, another populated repetition of Additional essage Information (526-FQ) follows it, and the text of the following message is a continuation of the current F HELP DESK PHONE NUBE Ø3 QUALIFIE 55Ø-8F HELP DESK PHONE NUBE 8ØØ ** End of esponse (B1) Payer Sheet **
19 2. FEQUENTLY ASKED QUESTIONS
20 3. APPENDI A. HISTOY OF IPLEENTATION GUIDE CHANGES 3.1 VESION 1.Ø July Initial Creation of Aetna NCPDP D.Ø (B1) edicare Payer Sheet. 3.2 VESION 2.Ø June odified ECL version to October 2011 from arch odified NCPDP Data Dictionary Version Date to October 2011 from arch VESION 3.Ø September odified 466-EZ PESCIBE ID QUALIFIE valid values to remove values: DEA (12), and State License (08). Note: Prescriber ID Qualifer field change is effective 1/1/2013. Added new value of 9 - Intermediate care facilities for the mentally retarded (ICF/) and Institutes for mental disease (ID) to PATIENT ESIDENCE. Updated 354-N SUBISSION CLAIFICATION CODE COUNT and 42Ø-DK SUBISSION CLAIFICATION CODE to be required when submitting for LTC Short Cycle Dispening or to override rejected claims due to a DU threshold being met. Added 429-DT SPECIAL PACKAGING INDICATO in the Claim Segment to be required when submitting for LTC Short Cycle Dispening. Added valid values to 42Ø-DK SUBISSION CLAIFICATION CODE and 429-DT SPECIAL PACKAGING INDICATO. Updated PATIENT ESIDENCE to be a required field and added valid values. Updated 147- U7 PHAACY SEVICE TYPE to be a required field. 3.4 VESION 4.Ø October Updated Patient esidence description of value 9 to state Intermediate care facilities for the mentally retarded (ICF/) and Institutes for mental disease (ID). Updated 42Ø-DK SUBISSION CLAIFICATION CODE to add "or when submitting a split billing claim from a LTC" Added value 19 Split Billing to 42Ø-DK SUBISSION CLAIFICATION CODE
AETNA NCPDP D.Ø CLAIM BILLING (B1) COMMERCIAL PAYER SHEET
AETNA NCPDP D.Ø CLAIM BILLING (B1) COMMECIAL PAYE SHEET IMPLEMENTATION GUIDE FO VESION D.Ø VESION 2.Ø June 2Ø12 TABLE OF CONTENTS 1. NCPDP VESION D CLAIM BILLING COMMECIAL... 3 1.1 EQUEST CLAIM BILLING
More informationNCPDP VERSION D.0 CLAIM BILLING MEDICAID/COMMERCIAL REQUEST CLAIM BILLING PRIMARY PAYER SHEET
NCPDP VESION D.0 CLAI BILLING EDICAID/COECIAL EQUEST CLAI BILLING PIAY PAYE SHEET GENEAL INFOATION Payer Name: Envolve Pharmacy Solutions Date: Plan Name/Group Name: Commercial/Non edicare D Plans BIN:
More informationNCPDP VERSION D.0 CLAIM BILLING MEDICAID/COMMERCIAL REQUEST CLAIM BILLING PRIMARY PAYER SHEET
NCPDP VESION D.0 CLAI BILLING EDICAID/COECIAL EQUEST CLAI BILLING PIAY PAYE SHEET GENEAL INFOATION Payer Name: US SCIPT Date: Plan Name/Group Name: edicaid/commercial/non edicare D Plans BIN: ØØ8Ø19 PCN:
More informationRESPONSE CLAIM BILLING NON-MEDICARE D PAYER SHEET ACCEPTED/PAID (OR DUPLICATE OF PAID) AND CAPTURED (OR DUPLICATE OF CAPTURED)
ESPONSE CLAI BILLING NON-EDICAE D PAYE SHEET ACCEPTED/PAID (O DUPLICATE OF PAID) AND CAPTUED (O DUPLICATE OF CAPTUED) GENEAL INFOATION Payer Name: Envolve Pharmacy Solutions Date: 10/1/2018 Plan Name/Group
More informationPayer Specification Sheet For Prime Therapeutics BCBS of Illinois Blue Cross Community ICP and FHP (Medicaid)
Payer Specification Sheet For Prime Therapeutics BCBS of Illinois Blue Cross Community ICP and FHP (edicaid) General information Prime Therapeutics LLC December 1, 2017 Plan Name BIN PCN BCBS of Illinois
More informationNCPDP VERSION D.0 CLAIM BILLING MEDICAID/COMMERCIAL REQUEST CLAIM BILLING PRIMARY PAYER SHEET
NCPDP VESION D.0 CLAI BILLING EDICAID/COECIAL EQUEST CLAI BILLING PIAY PAYE SHEET GENEAL INFOATION Payer Name: Envolve Pharmacy Solutions Date: Plan Name/Group Name: edicaid/commercial/non edicare D Plans
More informationNCPDP VERSION D.0 CLAIM BILLING MEDICAID/COMMERCIAL REQUEST CLAIM BILLING PRIMARY PAYER SHEET
Envolve Pharmacy Solutions NCPDP D.0 EPS-CNC Primary Sheet NCPDP VESION D.0 CLAI BILLING EDICAID/COECIAL EQUEST CLAI BILLING PIAY PAYE SHEET GENEAL INFOATION Name: Envolve Pharmacy Solutions Date: Plan
More informationCompanion Guide: NCPDP Versions D.0 and 1.2 Transaction Payer Sheet
HP P h a r m a c y U n i t I N D I A N A P E S C I P T I O N D U G P O G A Companion Guide: NCPDP Versions D.0 and 1.2 L I B A Y E F E E N C E N U B E : P P H 1 0 0 1 5 E V I S I O N D A T E : O C T O
More informationPayer Specification Sheet For Prime Therapeutics BCBS of New Mexico Blue Cross Community Centennial (Medicaid)
Specification Sheet For Prime Therapeutics BCBS of New exico Blue Cross Community Centennial (edicaid) General information Prime Therapeutics LLC January 24, 2018 Plan Name BIN PCN BCBS of New exico Blue
More informationPayer Sheet. Aetna Medicaid
Payer Sheet Aetna edicaid Table of Contents HIGHLIGHTS Updates, Changes & Reminders... 3 PART 1: GENERAL INFORATION... 4 PART 2: BILLING TRANSACTION / SEGENTS AND FIELDS... 5 PART 3: REVERSAL TRANSACTION...
More informationPayer Specification Sheet For Prime Therapeutics Medicare Part B Clients
Specification Sheet For Prime Therapeutics edicare Part B Clients General information Prime Therapeutics LLC January 8, 2019 Plan Name BIN PCN Arkansas BCBS edi Pak Advantage Part B Ø16895 PPARTB BCBS
More information2018 Payer Sheet NCPDP Version D.0. Version 1.0 for 2018
2018 Sheet NCPDP Version D.0 For all EDICARE serviced plans Version 1.0 for 2018 Effective Date: January 1, 2018 Contents General Information... 3 PB Information... 3 eridianrx edicare PCN List for 2018...
More informationPayer Specification Sheet For Prime Therapeutics Medicare Part B Clients
Specification Sheet For Prime Therapeutics edicare Part B Clients General information Prime Therapeutics LLC November 1, 2018 Plan Name BIN PCN Arkansas BCBS edi Pak Advantage Part B Ø16895 PPARTB BCBS
More information2019 Payer Sheet. Version 4.0 for 2019
2019 Payer Sheet Version 4.0 for 2019 Effective Date: January 1, 2019 Contents Contents... 2 General Information... 3 BIN Information... 3 List for BIN 610241... 3 List for BIN 017076... 3 List for BIN
More informationDC Medicaid Medical Assistance Programs
DC edicaid edical Assistance Programs Request Payer Sheet ** Start of Request (B2) Payer Sheet Template** GENERAL INFORATION Payer Name: DC edical Assistance Administration Date: January 1, 2Ø12 Plan Name/Group
More informationPayer Specification Sheet For Prime Therapeutics Commercial Clients
Specification Sheet For Prime Therapeutics Commercial Clients General information Prime Therapeutics LLC ay 26, 2016 Plan Name BIN PCN BCBS of Alabama Not Required ØØ4915 BCBS of Alabama Work Related Injury
More informationTexas Pharmacy Provider Payer Sheet
DOCUENT HISTORY LOG STATUS 1 REVISION 2 EFFECTIVE DESCRIPTION 3 Baseline 1.0 Jan. 1, 2017 Initial update. 1. Status should be represented as Baseline for initial issuances, Revision for changes to the
More informationHAWAII MEDICAID. REQUEST CLAIM REVERSAL PAYER SHEET TEMPLATE ** Start of Request Claim Reversal (B2) Payer Sheet Template** GENERAL INFORMATION
HAWAII EDICAID REQUEST CLAI REVERSAL PAYER SHEET TEPLATE ** Start of Request (B2) Payer Sheet Template** GENERAL INFORATION Payer Name: Hawaii edicaid Fee for Service Date: January 1, 2Ø12 Plan Name/Group
More informationMONTANA MEDICAID/MONTANA MENTAL HEALTH REQUEST CLAIM REVERSAL PAYER SHEET ** Start of Request Claim Reversal (B2) Payer Sheet Template**
ONTANA EDICAID/ONTANA ENTAL HEALTH REQUEST CLAI REVERSAL PAYER SHEET ** Start of Request (B2) Payer Sheet Template** GENERAL INFORATION Payer Name: ontana edicaid Date: January 1, 2Ø12 Plan Name/Group
More informationNCPDP Version D.Ø. For all MEDICARE serviced plans
MERIDIANRx-MEDICARE 2Ø15 Payer Sheet NCPDP Version D.Ø For all MEDICARE serviced plans Version 1.2 for 2Ø15 Release Date: February 5, 2Ø15 Effective Date: January 1, 2Ø15 Contents GENERAL INFORMATION...
More information2018 Payer Sheet NCPDP Version D.0. Version 3.0 for 2018
2018 Payer Sheet NCPDP Version D.0 Version 3.0 for 2018 Effective Date: January 1, 2018 Contents Contents... 2 General Information... 3 BIN Information... 3 List for BIN 610241... 3 List for BIN 017076...
More information2017 Payer Sheet NCPDP Version D.0. Version 1.0 for 2017
2017 Payer Sheet NCPDP Version D.0 Version 1.0 for 2017 Effective Date: January 1, 2017 Contents Contents... 2 General Information... 3 BIN Information... 3 PCN List for BIN 610241... 3 PCN List for 017076...
More informationVersion 1.2 for 2Ø15
MERIDIANRx 2Ø15 Payer Sheet NCPDP Version D.Ø Version 1.2 for 2Ø15 Release Date: May 28, 2Ø15 Effective Date: January 1, 2Ø15 Contents GENERAL INFORMATION... 3 BIN INFORMATION... 3 PCN LIST FOR BIN 61Ø241...
More informationGENERAL INFORMATION. FIELD LEGEND FOR COLUMNS Payer Usage Column
Department of Labor United States Department of Labor Division of Energy Employees Occupational Illness Compensation REQUEST CLAI REVERSAL PAYER SHEET ** Start of Request Claim Reversal (B2) Payer Sheet
More informationPayer Specification Sheet For Prime Therapeutics Commercial Clients
Specification Sheet For Prime Therapeutics Commercial Clients General information Prime Therapeutics LLC July 13, 2017 Plan Name BIN PCN BCBS of Alabama Not Required ØØ4915 BCBS of Alabama Work Related
More informationPayor Specification Information
Payor Specification Information for Pharmacies Participating in the First Health x Network First Health x is implementing NCPDP v.5.1 effective ctober 16, 2003. Please note that v.5.1 functionality will
More informationNATIONAL COUNCIL FOR PRESCRIPTION DRUG PROGRAMS (NCPDP) TELECOMMUNICATION VERSION D.0 AND BATCH TRANSACTION STANDARD VERSION 1.
NATIONAL COUNCIL FOR PRESCRIPTION DRUG PROGRAMS (NCPDP) TELECOMMUNICATION VERSION D.0 AND BATCH TRANSACTION STANDARD VERSION 1.2 COMPANION GUIDE Instructions Related to Transactions in NCPDP Telecommunication
More informationPayer Specification Sheet For Prime Therapeutics Commercial Clients
Specification Sheet For Prime Therapeutics Commercial Clients General information Prime Therapeutics LLC October 1, 2018 Plan Name BIN PCN BCBS of Alabama Not Required ØØ4915 BCBS of Alabama Work Related
More informationCynthia B. Jones, Director Department of Medical Assistance Services (DMAS)
Department of Medical Assistance Services 600 East Broad Street, Suite 1300 Richmond, Virginia 23219 MEDICAID MEMO http://www.dmas.state.va.us TO: FROM: SUBJECT: All Prescribing Providers and Pharmacists
More informationNCPDP, HIPAA, SCRIPT and v5.1 Overview
NCPDP, HIPAA, SCRIPT and v5.1 Overview Renée Branson April 26, 2002 Who Is NCPDP? NCPDP is an ANSI-accredited standards development organization representing the pharmacy industry. We are a membership
More informationNew HIPAA Update on NCPDP F2 Telecommunication Claim Standard
New HIPAA Update on NCPDP F2 Telecommunication Claim Standard NCPDP Standards Telecommunication Version F2 The Batch Standard The Batch Standard Subrogation guide Significant Changes from D.0 to F2 Expansion
More informationSYSTOC-to Professional Loop Maps for SYSTOC_EDI
SYSTC-to-837 40 Professional Loop aps for SYSTC_EDI Contents About 837 40 Professional Loop aps...3 Loop 1000A - Submitter Name...4 Loop 1000B - Receiver Identification...5 Loop 2000A - Billing / Pay-to-Provider...6
More informationSYSTOC-to Professional Loop Maps for SYSTOC_EDI
SYSTC-to-837 50 Professional Loop aps for SYSTC_EDI Contents About 837 50 Professional Loop aps...3 Loop 1000A - Submitter Name...4 Loop 1000B - Receiver Identification...5 Loop 2000A - Billing / Pay-to-Provider...6
More information1 Introduction to the Pharmacy Staff User Guide...1
1 Introduction to the Pharmacy Staff User Guide...1 2 EnterpriseRx Basics...5 EnterpriseRx Basics Overview...6 Mouse and Keyboard Overview...6 Using the Mouse...7 Using the Keyboard...8 Using Shortcut
More informationFederal Register /Vol. 72, No. 136 /Tuesday, July 17, 2007 /
Federal Register /Vol. 72, No. 136 /Tuesday, July 17, 2007 / 447.504 Determination of AMP. (a) AMP means, with respect to a covered outpatient drug of a manufacturer (including those sold under an NDA
More informationCoop-etition The pros and cons of collaboration with other standard-setting organizations
Coop-etition The pros and cons of collaboration with other standard-setting organizations Presented by Lynne Gilbertson VP Standards Development National Council for Prescription Drug Programs Open Forum
More informationORGANISATION CODE (PCT OF TESTING SERVICE) (RETIRED) renamed from ORGANISATION CODE (PCT OF TESTING SERVICE) SITE CODE (PROVIDER OF CHLAMYDIA TEST)
Page 1 of 8 Health and Social Care Information Centre NHS Data odel and Dictionary Service Type: Change equest eference: 1473 Version No: 1.0 Subject: Chlamydia Testing Activity Data Set Update Effective
More information867 Product Transfer and Resale Report
Health Industry Business Communications Council - ebusiness Committee 867 Product Transfer and Resale Report Introduction: Functional Group ID=PT This X12 Transaction Set contains the format and establishes
More informationCOMPOUND MEDICATION NON-FORMULARY (QUALIFIED HEALTH PLANS)
COMPOUND MEDICATION NON-FORMULARY (QUALIFIED HEALTH PLANS) Coverage for services, procedures, medical devices and drugs are dependent upon benefit eligibility as outlined in the member's specific benefit
More informationCBI Specialty Product Data Strategies. John Giannouris, VP Specialty Pharmacy Services
CBI Specialty Product Data Strategies John Giannouris, VP Specialty Pharmacy Services December 14, 2016 Speaker John Giannouris Vice President, Specialty Pharmacy Services ValueCentric john.giannouris@valuecentric.com
More informationOCREVUS Start Form. Instructions for Patients. Instructions for Health Care Providers
Instructions for Patients By completing this form: You will enroll in support services from Genentech You can apply to the Genentech Access to Care Foundation (GATCF) to determine if you are eligible to
More informationWelcome. A guide to using your OptumRx Pharmacy Benefit Services. LIVE YOUR LIFE. ENJOY YOUR LIFE.
Welcome A guide to using your OptumRx Pharmacy Benefit Services. LIVE YOUR LIFE. ENJOY YOUR LIFE. Welcome to your OptumRx Pharmacy Benefit Services Get the most out of your pharmacy benefi t services We
More informationSpecialty Pharmacy: Issues and Opportunities
Specialty Pharmacy: Issues and Opportunities Samm Anderegg, Pharm.D., MS, BCPS, CEO, DocStation Jocelyn Keegan, Payer/Provider Product Lead, Point of Care Partners Samm Anderegg, Pharm.D., MS, BCPS, CEO,
More informationPHARMACY DATA MANAGEMENT, INC. TRANSACTION SET HEALTH CARE CLAIM PAYMENT ADVICE VERSION ASC X X221 PDMI VERSION 2.1
PHARMACY DATA MANAGEMENT, INC. TRANSACTION SET 835 - HEALTH CARE CLAIM PAYMENT ADVICE VERSION ASC X-12 005010X221 PDMI VERSION 2.1 The following is a brief outline of the information will be sending in
More informationManufacturers Webinar
Manufacturers Webinar May 4, 2011 1 Announcements Quarter I Invoice Reports Distributed o Distributed on Friday April 29 th o Official Distribution Date April 30 th o Manufacturers pay Part D Sponsors
More informationCreated with you in mind. Prescription Benefits Guide
PHARMACY BENEFIT MANAGEMENT Created with you in mind. Prescription Benefits Guide Table of Contents Southern Scripts Overview and Contact 3 Information Your Plans Preferred Set-Up 4 ID Cards 5 Register
More informationVALIDATION ERRORS. No 6 Service not selected A Service must be selected on the Form. No 7 Billing Provider must have a Tax ID
1 Client not selected A Client must be selected on the Form. 2 Worker not selected A Worker must be selected on the Form. 3 Billing Provider not selected A Provider must be selected on the Form or on the
More informationAll Medicare Advantage, Cost, PACE, and Demonstration Organizations. CORRECTION - Encounter Data Software Releases
DEPATMENT OF HEALTH & HUMAN SEVICES Centers for Medicare & Medicaid Services 7500 Security Boulevard Baltimore, Maryland 21244-1850 CENTE FO MEDICAE MEDICAE PLAN PAYMENT GOUP DATE: September 27, 2016 TO:
More informationBRP Inc. ELECTRONIC DATA INTERCHANGE (EDI) IMPLEMENTATION GUIDE 830 VERSION 4010 FROM BRP INC. Document version 1.0
BRP Inc. ELECTRONIC DATA INTERCHANGE (EDI) IMPLEMENTATION GUIDE 830 VERSION 4010 FROM BRP INC. Document version 1.0 The following guide is intended to facilitate the user in implementing Electronic Data
More informationLast Revised: 3/2018 Prior Version: 12/2014 SOP NUMBER: SS-304 Page 1 of 4
STANDARD OPERATING PROCEDURE (SOP) FOR CLINICAL RESEARCH Title: Investigational Drug Billing Last Revised: 3/2018 Prior Version: 12/2014 SOP NUMBER: SS-304 Page 1 of 4 1. PURPOSE: To assure accurate and
More informationInitiative Overview. Initiative kicked off in the Summer of 2016 with a series of educational workshops
Initiative kicked off in the Summer of 2016 with a series of educational workshops Initiative Overview Participating employers expressed a desire to be more active in their specialty management HBCH Board
More informationOntario s Narcotics Strategy
Ontario Public Drug Programs Division Ontario s Narcotics Strategy Notice from the Executive Officer: Implementation of the Narcotics Monitoring System The Ministry of Health and Long-Term Care ( ministry
More informationSan Joaquin Valley Insurance Authority Prescription Drug RFP Analysis July 5 th, Michael E. Thomas, Pharm.D. V.P. National Pharmacy Management
San Joaquin Valley Insurance Authority Prescription Drug RFP Analysis July 5 th, 2012 Michael E. Thomas, Pharm.D. V.P. National Pharmacy Management PBM Information Pharmacy Benefit Management (PBM) Carve
More informationEFIOs and the NPI. Catherine Graeff, R.Ph., MBA Sr. Vice President, Communication & Industry Relations National Council for Prescription Drug Programs
EFIOs and the NPI Catherine Graeff, R.Ph., MBA Sr. Vice President, Communication & Industry Relations National Council for Prescription Drug Programs Topics What is EFI How EFI Works Becoming an EFIO Preparing
More informationNovember 14, 2014 **URGENT**
November 14, 2014 **URGENT** Attention Pharmacies: Catamaran, on behalf of our Client Cigna Health Plans, is sending you the attached onepage document, with all of the information your pharmacy should
More informationPrescription Drug Pricing. Page 1
Prescription Drug Pricing Page 1 Prescription Drugs As a Percent of Total National Health Expenditures, 1991-2014 12% 10% 8% 6% 4% 2% 0% 1991 1992 1993 1994 1995 1996 1997 1998 1999 2000 2001 2002 2003
More informationBiologics and Biosimilars Access and Traceability
Biologics and Biosimilars Access and Traceability Project Overview Summary: In-depth research and review of Biologics and Biosimilars as it relates to Healthcare Information Technology (HIT) Goal: Develop
More informationDSD Invoice TRANSACTION SET 810 VERSION 4010
DSD Invoice TRANSACTION SET 810 VERSION 4010 EDI provides an efficient means for our trading partner to submit invoices for payment. Receipt of the invoices, as well as an indication of any EDI-related
More informationKOHL S INVOICE PROGRAMMER'S REFERENCE GUIDE VERSION 4010VICS. Revised: July 10, 2015
PROGRAMMER'S REFERENCE GUIDE VERSION 4010VICS Revised: July 10, 2015 Within the retail industry, there exists two uses of the retail invoice document: Detail Invoicing and Consolidated Invoicing. Kohl
More informationHealth Reimbursement Arrangement (HRA) Implementation Packet
Health Reimbursement Arrangement (HRA) Implementation Packet Thank you for your interest in the Health Reimbursement Arrangement (HRA) benefit plan administration services offered by Allied Benefit Systems
More informationAdvanced Contracting Course
Advanced Contracting Course Stephanie Levin, AD, Commercial Data Acquisition & Scouting Bayer Healthcare Leslie Yendro, VP Business Development Avella Specialty Pharmacy Agenda Introduction Common Types
More information5010 Claims Filing. Aida Anderson HealthSystems Chandra Ross GE Healthcare
5010 Claims Filing Aida Anderson HealthSystems Chandra Ross GE Healthcare 2011 General Electric Company All rights reserved. This does not constitute a representation or warranty or documentation regarding
More informationCerpassRx Member Handbook
CerpassRx Member Handbook Welcome CerpassRx is pleased to administer your prescription benefit plan. About Us CerpassRx is an innovative Pharmacy Benefit Administrator that offers access to pharmacies
More informationBRP Inc. ELECTRONIC DATA INTERCHANGE (EDI) IMPLEMENTATION GUIDE 862 VERSION 4010 FROM BRP INC. Document version 1.0
BRP Inc. ELECTRONIC DATA INTERCHANGE (EDI) IMPLEMENTATION GUIDE 862 VERSION 4010 FROM BRP INC. Document version 1.0 The following guide is intended to facilitate the user in implementing Electronic Data
More informationIntroduction to the Generic Drug Supply Chain and Key Considerations for Policymakers
Association for Accessible Medicines Introduction to the Generic Drug Supply Chain and Key Considerations for Policymakers Key Takeaways Generic drugs play an important role in the U.S. health care system,
More informationPharmacy Industry Implementation for HIPAA Transaction Standards and Code Sets. NCVHS Subcommittee on Standards June 17, 2Ø11
Pharmacy Industry Implementation for HIPAA Transaction Standards and Code Sets NCVHS Subcommittee on Standards June 17, 2Ø11 1 What is NCPDP? An ANSI-accredited standards development organization. Provides
More informationCoding Systems Understanding NDC and HCPCS
Coding Systems Understanding NDC and HCPCS National Drug Code The National Drug Code (NDC) serves as a universal product identifier for prescription medications approved for human consumption. According
More informationNucleus Detailed Reference Guide
Nucleus Detailed Reference Guide Table of Contents Nucleus Overview Nucleus Login Screen 5 Nucleus Home Screen 6 Clearing Failed Doors 7 Practice Management Accessing Patient Screen 9 Adding a New Patient
More informationEDI Solutions Your guide to getting started -- and ensuring smooth transactions anthem.com/edi
EDI Solutions Your guide to getting started -- and ensuring smooth transactions anthem.com/edi 00175CAPEN (12/11) This brochure is a helpful EDI reference for both new and experienced electronic submitters.
More informationThe transition to OptumRx is designed to help us better serve your employees and help improve their overall experience:
September 27, 2013 RE: Pharmacy Benefit Transition Plan for Oxford Clients Dear Valued Oxford Client, We are pleased to confirm that, effective Oct. 1, 2013, your pharmacy benefit services are being administered
More informationBRP Inc. ELECTRONIC DATA INTERCHANGE (EDI) IMPLEMENTATION GUIDE 856 VERSION 4010 FROM SUPPLIER. Document version 1.1
BRP Inc. ELECTRONIC DATA INTERCHANGE (EDI) IMPLEMENTATION GUIDE 856 VERSION 4010 FROM SUPPLIER Document version 1.1 The following guide is intended to facilitate the user in implementing Electronic Data
More informationPittsburgh Glass Works. X Purchase Order Specifications
X-12 850 Purchase Order Specifications Contents 850 - Generic Purchase Order... 4 Introduction... 4 Heading... 4 Detail... 6 Summary... 6 Transaction Set Notes... 7 Segment: ST Transaction Set Header...
More informationImportant benefit information
Important benefit information Please keep for your records Welcome to Express Scripts! We re the manager of your home delivery benefit for Highmark Blue Cross Blue Shield West Virginia. We ll help you
More informationVoucher Build File Specifications XML (Extensible Markup Language)
Indiana Department of Child Services KidTraks Indiana Child Welfare Financial System Voucher Build File Specifications XML (Extensible Markup Language) Version: 1.6 0 P a g e Work Item Description: As
More informationImportant Prescription Benefit Information
Important Prescription Benefit Information Prepared Exclusively for: Wichita Center for Graduate Medical Education HDHP Plan medtrakrx.com Welcome to MedTrakRx Dear Member: This booklet contains important
More informationEaton Corporation Prescription Drug Benefit Managed by Express Scripts Frequently Asked Questions
1. Who is Express Scripts? Express Scripts is the pharmacy benefit manager that Eaton chose to administer your prescription drug benefit. Express Scripts administers the prescription benefit for all medical
More informationBRP Inc. ELECTRONIC DATA INTERCHANGE (EDI) IMPLEMENTATION GUIDE 856 VERSION 4010 FROM SUPPLIER. Document version 1.1
ELECTRONIC DATA INTERCHANGE (EDI) IMPLEMENTATION GUIDE 856 VERSION 4010 FROM SUPPLIER Document version 1.1 The following guide is intended to facilitate the user in implementing Electronic Data Interchange
More informationPCM & IHCA. Pharmaceutical Cost Containment & Invoicing Solution for Health Centers. Management Companies, Skilled Nursing Homes and LTC Facilities
PCM & IHCA Pharmaceutical Cost Containment & Invoicing Solution for Health Centers Management Companies, Skilled Nursing Homes and LTC Facilities Today s Agenda Who is PCM? The Root of the Problem The
More informationConnecticut interchange MMIS
Connecticut interchange MMIS Provider Manual EDI Options Chapter 6 Connecticut Department of Social Services (DSS) 55 Farmington Avenue Hartford, CT 06105 Hewlett Packard Enterprise 195 Scott Swamp Road
More informationPhysician Office Billing & Payment Guide
Physician Office Billing & Payment Guide Dermal Regeneration Matrix Dermal Repair Scaffold Ag Antimicrobial Dermal Repair Scaffold Physician Office Billing & Payment Guide Billing and Medicare Payment
More informationDoD Transportation Electronic Business (DTEB) Convention
Department of Defense DoD Transportation Electronic Business (DTEB) Convention ASC X12 Transaction Set 998 Rail Bill of Lading Cancellation (Version 004010) FINAL DRAFT December 2007 20071215 Department
More information2/10/ B: The Essentials. Statement of Conflict of Interest. CE Question
10 th Annual 340B Coalition Winter Conference Pre-Conference Workshop-Part 2 340B: The Essentials Rebecca Cheek, PharmD, BCACP, CACP Director of Pharmacy White House Clinics February 5, 2014 Statement
More informationAT&T Corporate Standard Specifications for New Horizons Wireline EDI 850 Purchase Order
850 Purchase Order Functional Group ID=PO Introduction: This Draft Standard for Trial Use contains the format and establishes the data contents of the Purchase Order Transaction Set (850) for use within
More information845 Price Authorization Acknowledgment/Status
Health Industry Business Communications Council - ebusiness Committee 845 Price Authorization Acknowledgment/Status Introduction: Functional Group ID=PA This X12 Transaction Set contains the format and
More informationEDI Implementation Guidelines DELIVERY SCHEDULE DELFOR. Shipping release for suppliers. (Based on EDIFACT Version 97-A) Date : July 2006 Versión 1
DELIVEY SCHEDULE -1 Shipping release for suppliers (Based on EDIFACT Version 97-A) Date : July 2006 Versión 1 Página 1 de 48 Table of Contents TITLE PAGE Table of Contents 2 Introduction 3 essage Description
More information855 IBM Guideline - Sales Order Ack to Customer ) - 03/17/06
855 IBM Guideline - Sales Order Ack to Customer - 004010) - 03/17/06 Introduction: Functional Group ID=PR This Draft Standard for Trial Use contains the format and establishes the data contents of the
More information211 Motor Carrier Bill of Lading
211 Motor Carrier Bill of Lading X12/V4010/211: 211 Motor Carrier Bill of Lading Version: 1.0 Final Publication: 1/27/2009 Notes: Table of Contents 211 Motor Carrier Bill of Lading...1 ISA Interchange
More informationSpecialty Pharmacy: Talk the Marketing Talk Success Factors of Specialty Sales
Specialty Pharmacy: Talk the Marketing Talk Success Factors of Specialty Sales Kristen Akervik Sales Director, Sterling Specialty Pharmacy 1 Disclosure Kristin Akervik, Sales Director, Sterling Specialty
More informationEDI GUIDELINES PURCHASE ORDER 850 FUNCTIONAL ACKNOWLEGEMENT 997 VERSION 4010
EDI GUIDELINES PURCHASE ORDER 850 FUNCTIONAL ACKNOWLEGEENT 997 VERSION 4010 Rev. 11/2/2007 GLOSSARY OF TERS Seg. Use: Reference : Number: : Consists of a segment identifier, one or more data element each
More information850 Purchase Order X12/V4010/850: 850 Purchase Order Version: 1.0
850 Purchase Order X12/V4010/850: 850 Purchase Order Version: 1.0 X12V4010 1 Exim 850 Purchase Order Functional Group=PO This Draft Standard for Trial Use contains the format and establishes the data contents
More information810 - Invoice. Version: X12
810 - Invoice Version: 004010 X12 Company: DOT FOODS, INC. Publication: 12/23/2010 810 Invoice Functional Group= IN Purpose: This Draft Standard for Trial Use contains the format and establishes the data
More information850 IBM Guideline - Purchase Order to Supplier - (004010) 03/21/06
850 IBM Guideline - Purchase Order to Supplier - (004010) 03/21/06 Introduction: Functional Group ID=PO This Draft Standard for Trial Use contains the format and establishes the data contents of the Purchase
More informationEDI Solutions Your guide to getting started -- and ensuring smooth transactions anthem.com/edi
EDI Solutions Your guide to getting started -- and ensuring smooth transactions anthem.com/edi 00175LNPEN (04/12) This brochure is a helpful EDI reference for both new and experienced electronic submitters.
More informationStandard Pharmaceutical Product Information (Rx Product Only)
Standard Pharmaceutical Product Information (Rx Product Only) August 2014 Introduction Type: Post Launch Change Final Version Date: Company Name: ZYDUS PHARMACEUTICALS (USA) INC. Application Number for
More information2015 Annual Convention
2015 Annual Convention Date: Tuesday, October 21, 2015 Time: 11:30 am 1:00 pm Location: Gaylord National Harbor Resort and Convention Center, National Harbor 2 Title: Activity Type: Speaker: How to Safeguard
More informationGeriMedProfiles. Consultant Pharmacist Software
GeriMedProfiles Consultant Pharmacist Software Features GerimedProfiles TM is a comprehensive medical database for clinical pharmacists Utilizes Microsoft Access as the core database allowing the end-user
More informationMail Service Pharmacy Convenient, Reliable Delivery
Mail Service Pharmacy Convenient, Reliable Delivery Walgreens Mail Service Easy and convenient, your prescription benefit includes the use of Walgreens Mail Service. Choosing mail service allows you to
More information276/277 Health Care Claim Status Request/Response Batch
Companion Document 276/277 276/277 Health Care Claim Status Request/Response Batch This companion document is for informational purposes only to describe certain aspects and expectations regarding the
More informationInstructions for Case Manager Survey
WYOMING DEPARTMENT OF HEALTH BEHAVIORAL HEALTH DIVISION Case Management Cost and Wage Survey Anticipated release date: September 5, 2017 Due date: October 10, 2017 Comprehensive, Supports and Acquired
More informationYour employees will enjoy the benefits of having an HRA.
HEALTH REIMBURSEMENT ARRANGEMENT (HRA) Your employees will enjoy the benefits of having an HRA. As an employer, you will too. HRA Plan designs and Pricing Plan Designs Option 1: Bridge Bridge Options:
More information