RPhLink - Wellpoint

RPhLink.com The Pharmaceutical Care Network!

From:       WELLPOINT Pharmacy Management      (HIPAA)

September 2003

The Health Insurance Portability Accountability Act of 1996 (known as HIPPA) includes provisions for Administrative Simplification, which require the Secretary of Health and Human services to adopt Data Standardization. In August 2000, the Department of Health and Human Services Administrative Simplification final rule on Transactions and Code sets was published in the Federal Registry. The rule adopts NCPDP Telecommunications Standard Format, Version 5.1 as the standard for pharmacy claims.

Wellpoint Pharmacy Management indicated a work plan on preparation for the standard updates. We are working with software vendors and pharmacies to facilitate the upcoming activities. Activities and dates include :

          * Certifying Software Vendors beginning August, 2003.

          * Conversion to ACS X12N835 Health Care Claim Payment/ Advice Bering August 2003.

          * Ability to accept live NCPDP 5.1 claims on September 12, 2003.

          ** No longer able to Accept Non-NCPDP 5.1 claims on October 16, 2003.

Implementation of NCPDP 5.1 will begin on September 12, 2003 using a phased approach. Prior to implementation your software vendor should be certified. Please contact your software vendor for the appropriate certification number.

NCPDP 5.1 claims may be submitted once you know that certification has been successfully active for your vendor.

Payer sheets for NCPDP 5.1 Billing and Response are attached. Please note the following items;

1. For drugs with decimal package sizes, NCPDP 5.1 requires that drug packages be entered using the metric decimal package size or a multiple of the metric decimal package sizes. The ability to submit rounded quantities no longer exists.

2. Partial fill is not supported. Please continue to submit your for claim for the partial amount and then reverse and resubmit when the fill is completed as allowed be NCPDP 5.1 .

3. Compound prescriptions should continue to be submitted using NDC of the highest cost ingredient. Multiple ingredient compound submissions are not supported.

4. COB transactions from pharmacy providers are not supported. COB will continue to be processed on a paper submissions from the member with an attached receipt.

WE will continue to keep you apprised of upcoming dates and deadlines as implementation approaches. If you should have any questions or concerns regarding NCPDP 5.1, please contact Wellpoint Pharmacy management's Help Line at 1-800-962-7378.

More News from Kinray| Previous News | Front Page!

General Pharmacy Classified | Pharmacy Antiques | Pharmacy Collectibles | Pharmacy Archives