ncpdp, hippa, script and v5.1 overview phillip d. scott ncpdp senior vice president july 10, 2001
TRANSCRIPT
![Page 1: NCPDP, HIPPA, SCRIPT and V5.1 Overview Phillip D. Scott NCPDP Senior Vice President July 10, 2001](https://reader031.vdocuments.us/reader031/viewer/2022032307/56649cb15503460f94975ede/html5/thumbnails/1.jpg)
NCPDP, HIPPA, SCRIPT and V5.1 Overview
Phillip D. ScottNCPDP Senior Vice President
July 10, 2001
![Page 2: NCPDP, HIPPA, SCRIPT and V5.1 Overview Phillip D. Scott NCPDP Senior Vice President July 10, 2001](https://reader031.vdocuments.us/reader031/viewer/2022032307/56649cb15503460f94975ede/html5/thumbnails/2.jpg)
Agenda
• Who is NCPDP?
• Where have we been?
• Where are we?
• Where are we going?
• How can I get involved?
![Page 3: NCPDP, HIPPA, SCRIPT and V5.1 Overview Phillip D. Scott NCPDP Senior Vice President July 10, 2001](https://reader031.vdocuments.us/reader031/viewer/2022032307/56649cb15503460f94975ede/html5/thumbnails/3.jpg)
Who is NCPDP?
![Page 4: NCPDP, HIPPA, SCRIPT and V5.1 Overview Phillip D. Scott NCPDP Senior Vice President July 10, 2001](https://reader031.vdocuments.us/reader031/viewer/2022032307/56649cb15503460f94975ede/html5/thumbnails/4.jpg)
Who is NCPDP?
The National Council for Prescription Drug Programs (NCPDP) is an ANSI-
accredited standards development organization representing all facets of
pharmacy. We are a membership driven organization that was named in federal
legislation (HIPAA).
![Page 5: NCPDP, HIPPA, SCRIPT and V5.1 Overview Phillip D. Scott NCPDP Senior Vice President July 10, 2001](https://reader031.vdocuments.us/reader031/viewer/2022032307/56649cb15503460f94975ede/html5/thumbnails/5.jpg)
Mission Statement
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.
![Page 6: NCPDP, HIPPA, SCRIPT and V5.1 Overview Phillip D. Scott NCPDP Senior Vice President July 10, 2001](https://reader031.vdocuments.us/reader031/viewer/2022032307/56649cb15503460f94975ede/html5/thumbnails/6.jpg)
Vision Statement
To be the model forum which empowers our members to enhance the quality of
health care through the creation of information solutions.
![Page 7: NCPDP, HIPPA, SCRIPT and V5.1 Overview Phillip D. Scott NCPDP Senior Vice President July 10, 2001](https://reader031.vdocuments.us/reader031/viewer/2022032307/56649cb15503460f94975ede/html5/thumbnails/7.jpg)
Membership Representation• Producer/Provider (pink badges)
– Retail Pharmacy, Mail Service Pharmacy, Consulting Pharmacists, and Manufacturers
• Payer/Processor (green badges) – BCBS Organizations, HMOs, PBMs, and
Government Payers
• Vendors and General Interest (yellow badges)– Drug Wholesalers, Consultants, Clinical Programs,
and Software & Hardware Vendors
![Page 8: NCPDP, HIPPA, SCRIPT and V5.1 Overview Phillip D. Scott NCPDP Senior Vice President July 10, 2001](https://reader031.vdocuments.us/reader031/viewer/2022032307/56649cb15503460f94975ede/html5/thumbnails/8.jpg)
Voting Categories
Producer/Provider
314
Payer/Processor
509
Vendor/General Interest 477
Total Members = 1301
![Page 9: NCPDP, HIPPA, SCRIPT and V5.1 Overview Phillip D. Scott NCPDP Senior Vice President July 10, 2001](https://reader031.vdocuments.us/reader031/viewer/2022032307/56649cb15503460f94975ede/html5/thumbnails/9.jpg)
Where Have We Been?
![Page 10: NCPDP, HIPPA, SCRIPT and V5.1 Overview Phillip D. Scott NCPDP Senior Vice President July 10, 2001](https://reader031.vdocuments.us/reader031/viewer/2022032307/56649cb15503460f94975ede/html5/thumbnails/10.jpg)
NCPDP History
Pharmacies started installing computer systems in the late 1970’s First systems were installed on the IBM Series 1
Pharmacies started submitting computer generated paper claims to insurance companies
Every insurance company had their own unique form
![Page 11: NCPDP, HIPPA, SCRIPT and V5.1 Overview Phillip D. Scott NCPDP Senior Vice President July 10, 2001](https://reader031.vdocuments.us/reader031/viewer/2022032307/56649cb15503460f94975ede/html5/thumbnails/11.jpg)
NCPDP History
NCPDP was formed in 1977 to standardize insurance forms.
NCPDP’s first standardization effort was the paper universal claim form (UCF) which was adopted in 1978. Over three billion claim forms have been distributed.
![Page 12: NCPDP, HIPPA, SCRIPT and V5.1 Overview Phillip D. Scott NCPDP Senior Vice President July 10, 2001](https://reader031.vdocuments.us/reader031/viewer/2022032307/56649cb15503460f94975ede/html5/thumbnails/12.jpg)
NCPDP History
1987 PCS introduced electronic claims Black Box that uses telephone line to call
PCS direct Proprietary format
Other PBMs (Pharmacy Benefit Managers) followedInstead of multiple form types, pharmacies now had multiple black boxes on their counters
![Page 13: NCPDP, HIPPA, SCRIPT and V5.1 Overview Phillip D. Scott NCPDP Senior Vice President July 10, 2001](https://reader031.vdocuments.us/reader031/viewer/2022032307/56649cb15503460f94975ede/html5/thumbnails/13.jpg)
NCPDP History
1988 NCPDP developed Version 1.0 of the Telecommunication Standard1988 Pharmacy software vendors and chains started coding for electronic claims No more double entry No need for black boxes Use of switching companies like
ENVOY/WebMD and NDC Health
![Page 14: NCPDP, HIPPA, SCRIPT and V5.1 Overview Phillip D. Scott NCPDP Senior Vice President July 10, 2001](https://reader031.vdocuments.us/reader031/viewer/2022032307/56649cb15503460f94975ede/html5/thumbnails/14.jpg)
Where Are We?
![Page 15: NCPDP, HIPPA, SCRIPT and V5.1 Overview Phillip D. Scott NCPDP Senior Vice President July 10, 2001](https://reader031.vdocuments.us/reader031/viewer/2022032307/56649cb15503460f94975ede/html5/thumbnails/15.jpg)
Standards Related to Electronic Prescribing
NCPDP has two standards that directly relate to electronic prescribing:
Telecommunication Standard
SCRIPT Standard
![Page 16: NCPDP, HIPPA, SCRIPT and V5.1 Overview Phillip D. Scott NCPDP Senior Vice President July 10, 2001](https://reader031.vdocuments.us/reader031/viewer/2022032307/56649cb15503460f94975ede/html5/thumbnails/16.jpg)
What is Telecom? Telecom is a data transmission standard
intended to facilitate the communication of prescription information between pharmacies and payers. It is used billions of times each year.
![Page 17: NCPDP, HIPPA, SCRIPT and V5.1 Overview Phillip D. Scott NCPDP Senior Vice President July 10, 2001](https://reader031.vdocuments.us/reader031/viewer/2022032307/56649cb15503460f94975ede/html5/thumbnails/17.jpg)
Telecom Standard Version History
Version 1.0 released in 1988
Version 3.2 in 1992
Version 3.3 in 1996 Compound Ingredients
Version 4.0 in 1997
Version 5.0 in 1999
![Page 18: NCPDP, HIPPA, SCRIPT and V5.1 Overview Phillip D. Scott NCPDP Senior Vice President July 10, 2001](https://reader031.vdocuments.us/reader031/viewer/2022032307/56649cb15503460f94975ede/html5/thumbnails/18.jpg)
What is SCRIPT?
SCRIPT is a data transmission standard intended to facilitate the communication of prescription information between prescribers and pharmacists.
![Page 19: NCPDP, HIPPA, SCRIPT and V5.1 Overview Phillip D. Scott NCPDP Senior Vice President July 10, 2001](https://reader031.vdocuments.us/reader031/viewer/2022032307/56649cb15503460f94975ede/html5/thumbnails/19.jpg)
SCRIPT Standard Version History
Version 1.0 was approved in April 1997
Version 3.1 was ANSI Accredited in 2000
Version 4.1 is in balloting status now
![Page 20: NCPDP, HIPPA, SCRIPT and V5.1 Overview Phillip D. Scott NCPDP Senior Vice President July 10, 2001](https://reader031.vdocuments.us/reader031/viewer/2022032307/56649cb15503460f94975ede/html5/thumbnails/20.jpg)
SCRIPT Can Be Used For
New Prescriptions from the prescriber to the pharmacyChange Requests to New Prescriptions by the pharmacy to the prescriberRefill Requests by the pharmacy to the prescriber
![Page 21: NCPDP, HIPPA, SCRIPT and V5.1 Overview Phillip D. Scott NCPDP Senior Vice President July 10, 2001](https://reader031.vdocuments.us/reader031/viewer/2022032307/56649cb15503460f94975ede/html5/thumbnails/21.jpg)
SCRIPT Can Be Used ForFill Status from the pharmacy to the prescriber (patient picked up, patient picked up partial fill, patient never picked up)The ability for a prescriber to cancel a previously submitted requestHousekeeping transactions (password change, receive prescriptions, et cetera)
![Page 22: NCPDP, HIPPA, SCRIPT and V5.1 Overview Phillip D. Scott NCPDP Senior Vice President July 10, 2001](https://reader031.vdocuments.us/reader031/viewer/2022032307/56649cb15503460f94975ede/html5/thumbnails/22.jpg)
Every Business Request Transaction Includes:
Electronic envelopeSection to define the PrescriberSection to define the PharmacySection to define the Patient
![Page 23: NCPDP, HIPPA, SCRIPT and V5.1 Overview Phillip D. Scott NCPDP Senior Vice President July 10, 2001](https://reader031.vdocuments.us/reader031/viewer/2022032307/56649cb15503460f94975ede/html5/thumbnails/23.jpg)
Electronic Envelope Includes:
Sender ID
Receiver ID
Syntax information (version/release, delimiters)
Type of Message
Password
Trace Numbers
Date/Time
![Page 24: NCPDP, HIPPA, SCRIPT and V5.1 Overview Phillip D. Scott NCPDP Senior Vice President July 10, 2001](https://reader031.vdocuments.us/reader031/viewer/2022032307/56649cb15503460f94975ede/html5/thumbnails/24.jpg)
Prescriber Information May Include:
Identifier (State License, DEA, etc)
Prescriber name
Business name
Business address information
Phone number (telephone, beeper, fax)
Specialty Code (AMA Self-Designated Practice Specialty/Areas of Practice Code)
Authorizing Prescriber Agent Name
![Page 25: NCPDP, HIPPA, SCRIPT and V5.1 Overview Phillip D. Scott NCPDP Senior Vice President July 10, 2001](https://reader031.vdocuments.us/reader031/viewer/2022032307/56649cb15503460f94975ede/html5/thumbnails/25.jpg)
Pharmacy Information May Include:
Identifier (NCPDP Provider ID)
Pharmacy name
Pharmacist name
Pharmacy address information
Phone number (telephone, beeper, fax)
![Page 26: NCPDP, HIPPA, SCRIPT and V5.1 Overview Phillip D. Scott NCPDP Senior Vice President July 10, 2001](https://reader031.vdocuments.us/reader031/viewer/2022032307/56649cb15503460f94975ede/html5/thumbnails/26.jpg)
Patient Information May Include:
Patient Name
Date of Birth
Gender
Patient Address
Patient Phone Number
Relationship to Cardholder
Pharmacy/Prescriber’s internal Patient ID
![Page 27: NCPDP, HIPPA, SCRIPT and V5.1 Overview Phillip D. Scott NCPDP Senior Vice President July 10, 2001](https://reader031.vdocuments.us/reader031/viewer/2022032307/56649cb15503460f94975ede/html5/thumbnails/27.jpg)
Every Response Transaction Includes:
Electronic envelope
Response Status Acknowledgement of the receipt of the transaction
or “Paired” response transaction to the request which
may Approve the request Approve the request with changes Deny the request
Acknowledgement of an error in the transaction
![Page 28: NCPDP, HIPPA, SCRIPT and V5.1 Overview Phillip D. Scott NCPDP Senior Vice President July 10, 2001](https://reader031.vdocuments.us/reader031/viewer/2022032307/56649cb15503460f94975ede/html5/thumbnails/28.jpg)
Version 5
HIPPA Legislated Standard
![Page 29: NCPDP, HIPPA, SCRIPT and V5.1 Overview Phillip D. Scott NCPDP Senior Vice President July 10, 2001](https://reader031.vdocuments.us/reader031/viewer/2022032307/56649cb15503460f94975ede/html5/thumbnails/29.jpg)
Enhancements requested & approved for Version 5
Version 5 is a complete rewrite to the NCPDP Telecommunication Standard. It includes: New data elements Removed obsolete data elements
deleted Additions/modifications to the data
dictionary
![Page 30: NCPDP, HIPPA, SCRIPT and V5.1 Overview Phillip D. Scott NCPDP Senior Vice President July 10, 2001](https://reader031.vdocuments.us/reader031/viewer/2022032307/56649cb15503460f94975ede/html5/thumbnails/30.jpg)
Enhancements requested & approved for Version 5
The $ fields size have been increased Old size maximum was $9,999.99 New size is $999,999.99
Field Qualifiers were added NDC or UPC DEA, State License #, UPIN or Third Party ID
Enhanced Coordination of Benefits Secondary/Tertiary can see primary reject
codes Secondary/Tertiary can see all primary
payments (both Rx and Service Claims)
![Page 31: NCPDP, HIPPA, SCRIPT and V5.1 Overview Phillip D. Scott NCPDP Senior Vice President July 10, 2001](https://reader031.vdocuments.us/reader031/viewer/2022032307/56649cb15503460f94975ede/html5/thumbnails/31.jpg)
Enhancements requested & approved for Version 5
Expanded DUR (Drug Utilization Review) capability Ability for Provider to respond to multiple
alerts (Reason for Service Codes) in one transaction
Ability for Providers to send PPS codes and supporting info on claim
Professional Service Claim Claim can be submitted for service without
having to have an Rx Service Claim can refer to an Rx Easier for pharmacy to reconcile
![Page 32: NCPDP, HIPPA, SCRIPT and V5.1 Overview Phillip D. Scott NCPDP Senior Vice President July 10, 2001](https://reader031.vdocuments.us/reader031/viewer/2022032307/56649cb15503460f94975ede/html5/thumbnails/32.jpg)
Enhancements requested & approved for Version 5
Partial Fill capability Pharmacy can report the dispensing
of an initial partial fill (25 out of 30) Pharmacy can report the dispensing
of the remaining quantity without Additional dispensing fee Additional refill number DUR warnings
Duplicate therapy Too soon to refill
![Page 33: NCPDP, HIPPA, SCRIPT and V5.1 Overview Phillip D. Scott NCPDP Senior Vice President July 10, 2001](https://reader031.vdocuments.us/reader031/viewer/2022032307/56649cb15503460f94975ede/html5/thumbnails/33.jpg)
What’s new in Version 5?Segments restructures for efficiency Data elements grouped into logical
segments Variable format
Additional business functions Prior authorization enhanced Controlled substance reporting added Information reporting added
![Page 34: NCPDP, HIPPA, SCRIPT and V5.1 Overview Phillip D. Scott NCPDP Senior Vice President July 10, 2001](https://reader031.vdocuments.us/reader031/viewer/2022032307/56649cb15503460f94975ede/html5/thumbnails/34.jpg)
Where are We Going?
![Page 35: NCPDP, HIPPA, SCRIPT and V5.1 Overview Phillip D. Scott NCPDP Senior Vice President July 10, 2001](https://reader031.vdocuments.us/reader031/viewer/2022032307/56649cb15503460f94975ede/html5/thumbnails/35.jpg)
What We Know About HIPAA
• NCPDP Telecommunication Standard v5.1
• NCPDP Batch Standard v1.1
• ASC X12N 834
• ASC X12N 835
• Privacy Rules
![Page 36: NCPDP, HIPPA, SCRIPT and V5.1 Overview Phillip D. Scott NCPDP Senior Vice President July 10, 2001](https://reader031.vdocuments.us/reader031/viewer/2022032307/56649cb15503460f94975ede/html5/thumbnails/36.jpg)
What is Still to Come with HIPAA?
NPRM for Transactions and Code Sets (revisions/clarifications)NPRM for NDC versus HCPCS ClarificationsUnique Identifiers for Providers, Payers, Employers, and IndividualsSecurity RulesPrivacy Rule ModificationsEnforcement Rules
![Page 37: NCPDP, HIPPA, SCRIPT and V5.1 Overview Phillip D. Scott NCPDP Senior Vice President July 10, 2001](https://reader031.vdocuments.us/reader031/viewer/2022032307/56649cb15503460f94975ede/html5/thumbnails/37.jpg)
How NCPDP Helps Industry Plan for HIPAA?
NCPDP is a Designated Standards Maintenance Organization (DSMO) Pharmacy Strategic National Implementation Process (SNIP)August SummitWork Groups Continue to Monitor and Respond to HIPAA Rules Task Groups working to answer DHHS questions
![Page 38: NCPDP, HIPPA, SCRIPT and V5.1 Overview Phillip D. Scott NCPDP Senior Vice President July 10, 2001](https://reader031.vdocuments.us/reader031/viewer/2022032307/56649cb15503460f94975ede/html5/thumbnails/38.jpg)
Future Initiatives NCPDP has In Store
The Council’s newest project, HCIdea,
will establish a unique identifier
for prescribers.
![Page 39: NCPDP, HIPPA, SCRIPT and V5.1 Overview Phillip D. Scott NCPDP Senior Vice President July 10, 2001](https://reader031.vdocuments.us/reader031/viewer/2022032307/56649cb15503460f94975ede/html5/thumbnails/39.jpg)
How Can I Get Involved?
![Page 40: NCPDP, HIPPA, SCRIPT and V5.1 Overview Phillip D. Scott NCPDP Senior Vice President July 10, 2001](https://reader031.vdocuments.us/reader031/viewer/2022032307/56649cb15503460f94975ede/html5/thumbnails/40.jpg)
Attend NCPDP Meetings
August 2001 in Baltimore, MD4th Summit
5th Educational Forum6th – 8th Work Groups
November 2001 in Orlando, FL13th Educational Forum14th – 16th Work Groups
March 2002 in Phoenix, AZ23rd – 24th Work Groups24th – 27th Conference
![Page 41: NCPDP, HIPPA, SCRIPT and V5.1 Overview Phillip D. Scott NCPDP Senior Vice President July 10, 2001](https://reader031.vdocuments.us/reader031/viewer/2022032307/56649cb15503460f94975ede/html5/thumbnails/41.jpg)
How Can I Follow the Council’s Activities?
Become a memberAttend the quarterly Work Group MeetingsNCPDP NowWebsite (www.ncpdp.org)Council ConnectionAsk a Staff Member