Health Care Eligibility Benefit Inquiry and Response for Retail Pharmacy Coverage

Type	Standard / Implementation Specification	Standards Process Maturity	Implementation Maturity	Federally required	Cost	Test Tool Availability
Implementation Specification	NCPDP® Telecommunication Standard Implementation Guide, Version D, Release 0 (Version D.0), August 2010 and equivalent Batch Standard Implementation Guide Version 1.2	Final	Production	Yes	$	Yes
Implementation Specification	NCPDP Telecommunication Standard, Implementation Guide, Version F6, April 2022 and Equivalent Batch Standard Implementation Guide, Version 15 https://standards.ncpdp.org/Access-to-Standards.aspx	Final	Production	No	$	No
Implementation Specification	NCPDP Real-Time Prescription Benefit Standard Version 12	Final	Production	No	$	No

Limitations, Dependencies, and Preconditions for Consideration	Applicable Security Patterns for Consideration
The Administrative Simplification provisions of HIPAA apply to the adoption of electronic transaction standards and operating rules for covered entities, which includes health plans, health care clearinghouses and certain health care providers. Information about the HIPAA regulations and enforcement can be found at https://www.cms.gov/Regulations-and-Guidance/Administrative-Simplification/HIPAA-ACA/index.html. Costs to access the NCPDP standards are based on membership status. NCPDP's Standards Matrix is available as a reference providing a high-level overview of the latest version/release and/or the most commonly used of NCPDP standards and implementation guides, as well as NCPDP’s Data Dictionary and External Code List. NCVHS made a recommendation to HHS to adopt the Telecommunication Standard Implementation Guide Version F6 and Subrogation Version 15 in 2019, requesting adoption through rulemaking in CY 2020. Find the history for this recommendation information on the NCVHS website.	All covered entities and their business associates are required to comply with the HIPAA Privacy and Security Rules. Health and Human Services has partnered with the Office of the National Coordinator and the National Institutes of Standards and Technology to publish comprehensive guidance for Security specific to electronic protected health information. A self-assessment tool kit is available to support integrating privacy and security into practices.

Limitations, Dependencies, and Preconditions for Consideration

Applicable Security Patterns for Consideration

The Administrative Simplification provisions of HIPAA apply to the adoption of electronic transaction standards and operating rules for covered entities, which includes health plans, health care clearinghouses and certain health care providers. Information about the HIPAA regulations and enforcement can be found at https://www.cms.gov/Regulations-and-Guidance/Administrative-Simplification/HIPAA-ACA/index.html.
Costs to access the NCPDP standards are based on membership status. NCPDP's Standards Matrix is available as a reference providing a high-level overview of the latest version/release and/or the most commonly used of NCPDP standards and implementation guides, as well as NCPDP’s Data Dictionary and External Code List.
NCVHS made a recommendation to HHS to adopt the Telecommunication Standard Implementation Guide Version F6 and Subrogation Version 15 in 2019, requesting adoption through rulemaking in CY 2020. Find the history for this recommendation information on the NCVHS website.

All covered entities and their business associates are required to comply with the HIPAA Privacy and Security Rules. Health and Human Services has partnered with the Office of the National Coordinator and the National Institutes of Standards and Technology to publish comprehensive guidance for Security specific to electronic protected health information. A self-assessment tool kit is available to support integrating privacy and security into practices.

Comment

Submitted by pwilson@ncpdp.org on 2022-09-30

NCPDP Comments

NCPDP recommends to update: NCPDP Telecommunication Standard, Implementation Guide, Version F6, April 2020 and Equivalent Batch Standard Implementation Guide, Version 15 to the following:
1. NCPDP Telecommunication Standard, Implementation Guide Version F6, April 2022 and equivalent Batch Standard Implementation Guide Version 15

Submitted by pwilson@ncpdp.org on 2021-09-29

NCPDP Comments

NCPDP Telecommunication Standard, Implementation Guide, Version F6, April 2020 and equivalent Batch Standard Implementation Guide, Version 15 is published, adoption level of N/A and not Federally Required yet. NCPDP has requested these versions be named under HIPAA.
Add the following:

Type-Implementation Specification Standard Implementation/Specification- NCPDP Real-Time Prescription Benefit Standard Version 12 Standards Process Maturity – Final Implementation Maturity – Production Adoption Level – 1 Federally required – No Cost - $ Test Tool Availability – No

Update the following: NCPDP Telecommunication Standard Implementation Guide, Version D, Release 0 (Version D.0), August 2010 add the equivalent Batch Standard Implementation Guide Version 1.2

Submitted by doodles531 on 2020-12-13

updated weblink for NCPDP standard

updated link for NCPDP due to 404 error on prior link

Submitted by pwilson@ncpdp.org on 2020-11-07

NCPDP Comment

Add the following:

Type-Implementation Specification Standard Implementation/Specification- NCPDP Real Time Prescription Benefit Standard Standards Process Maturity – Final Implementation Maturity – Production Adoption Level – 1 Federally required – No Cost - $ Test Tool Availability – No

Remove the following statement: NCPDP is developing a Real Time Prescription Benefit standard that should be monitored as a potential emerging implementation specification. It is currently in beta status, with anticipated balloting expected Fall 2019.
Modify the following:

Type-Implementation Specification Standard Implementation/Specification- NCPDP Telecommunication Standard, Implementation Guide, Version F6, April 2020 and Equivalent Batch Standard Implementation Guide, Version 15

Submitted by pwilson@ncpdp.org on 2019-09-24

NCPDP Comment

Remove “NCPDP is in the investigative stage of providing a test tool” under Limitations, Dependencies, and Preconditions for Consideration.

Submitted by pwilson@ncpdp.org on 2018-10-01

NCPDP Comment

Type-Implementation Specification

Standard Implementation/Specification- NCPDP Telecommunication Standard, Implementation Guide, Version F2, March 2018 and Equivalent Batch Standard Implementation Guide, Version 15

Standards Process Maturity – Final

Implementation Maturity- Pilot

Adoption Level – 1

Federally Required – No

Cost – $

Test Tool Availability – No.

Limitations, Dependencies, and Preconditions for Consideration
The Telecommunication Standard Implementation Guide Version F2 has been requested to be adopted under HIPAA. NCPDP is in the investigative stage of providing a test tool.

Submitted by shellyspiro on 2018-10-01

Pharmacy HIT Collaborative's Comments on ONC's Proposed 2018 ISA

The Pharmacy HIT Collaborative supports the use of NCPDP Telecommunications Standard Implementation Guide, Version D, Release 0.

Submitted by pwilson@ncpdp.org on 2017-11-20

NCPDP - Comment

The Standard Listed – NCPDP Version D.0 is incorrect. The Standard and Implementation Guide are not separated. There is no separate standard and the Standard section material should be deleted.
Standard Implementation/Specification: incorrectly lists the wrong version of the Telecommunication Standard Implementation Guide. It should be Telecommunication Standard Implementation Guide, Version D, Release 0 (Version D.0), August 2010.

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Health Care Eligibility Benefit Inquiry and Response for Retail Pharmacy Coverage

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NCPDP Comments

updated weblink for NCPDP standard

NCPDP Comment

NCPDP Comment

NCPDP Comment

Pharmacy HIT Collaborative's Comments on ONC's Proposed 2018 ISA

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