Referral Certification and Authorization for Pharmacy Transactions

Type	Standard / Implementation Specification	Standards Process Maturity	Implementation Maturity	Adoption Level	Federally required	Cost	Test Tool Availability
Implementation Specification	NCPDP® Telecommunication Standard Implementation Guide, Version D, Release 0 (Version D.0), August 2010	Final	Production		Yes	$	Yes
Implementation Specification	NCPDP SCRIPT Standard, Implementation Guide, Version 2017071	Final	Production		No	$	No
Implementation Specification	NCPDP Telecommunication Standard, Implementation Guide, Version F6, April 2022	Final	Production		No	$	No
Implementation Specification	NCPDP SCRIPT Standard, Implementation Guide, Version 2023011	Final	Feedback requested	Feedback Requested	Yes
Implementation Specification	HL7 FHIR DaVinci Clinical Data Exchange (CDex) Implementation Guide	Balloted Draft	Pilot		No	Free	No

Limitations, Dependencies, and Preconditions for Consideration	Applicable Security Patterns for Consideration
Updated referral transactions are published in the NCPDP SCRIPT Standard Version 2022011. These transactions are currently available for use by trading partner agreement. In 2019, NCVHS recommended that HHS adopt the Telecommunication Standard Implementation Guide Version F6 and Subrogation (as HIPAA Standards). Adoption of this updated standard is pending HHS rulemaking. NCPDP requested that HHS adopt the NCPDP SCRIPT standard for prior authorization under HIPAA. This standard has since been adopted under the Medicare Part D program. Check the Federal Register for current rules. Costs for access to the NCPDP standards are based on membership. 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. All operating rules are incorporated as part of the NCPDP standards and separate operating rules are not adopted under HIPAA for pharmacy standards; including for the NCPDP SCRIPT standard.	Feedback requested.

Limitations, Dependencies, and Preconditions for Consideration

Applicable Security Patterns for Consideration

Updated referral transactions are published in the NCPDP SCRIPT Standard Version 2022011. These transactions are currently available for use by trading partner agreement.
In 2019, NCVHS recommended that HHS adopt the Telecommunication Standard Implementation Guide Version F6 and Subrogation (as HIPAA Standards). Adoption of this updated standard is pending HHS rulemaking.
NCPDP requested that HHS adopt the NCPDP SCRIPT standard for prior authorization under HIPAA. This standard has since been adopted under the Medicare Part D program. Check the Federal Register for current rules.
Costs for access to the NCPDP standards are based on membership. 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.
All operating rules are incorporated as part of the NCPDP standards and separate operating rules are not adopted under HIPAA for pharmacy standards; including for the NCPDP SCRIPT standard.

Feedback requested.

Comment

Submitted by pwilson@ncpdp.org on 2024-08-13

NCPDP Comment

NCPDP recommends removing NCPDP SCRIPT Standard, Implementation Guide, Version 2022011, as this version was never implemented. NCPDP SCRIPT Standard Implementation Guide, Version 2023011 is the next version named by ASTP/ONC and Medicare. Federally required should be changed to a Yes for the NCPDP SCRIPT Standard Implementation Guide, Version 2023011.

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

NCPDP Comments

NCPDP recommends updating:NCPDP SCRIPT Standard Implementation Guide Version 2020101 to the following:
1. NCPDP SCRIPT Standard Implementation Guide Version 2022011

NCPDP recommends updating:NCPDP Telecommunication Standard, Implementation Guide, Version F6, April 2020 to the following:
1. NCPDP Telecommunication Standard, Implementation Guide Version F6, April 2022

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

NCPDP Comments

Update the following: NCPDP SCRIPT Standard Implementation Guide, Version 2013101 should be removed.
Update the following: NCPDP SCRIPT Standard, Implementation Guide, Version 2017071 should be production and level 5.
Update the following:

Type-Implementation Specification

Standard Implementation/Specification- NCPDP SCRIPT Standard Implementation Guide Version 2020101

Standards Process Maturity – Final

Implementation Maturity – Published

Adoption Level – N/A

Federally required – No

Cost - $

Test Tool Availability – No

Referral transactions published in the NCPDP SCRIPT Standard Version 2020101. These transactions are currently available for use by trading partner agreement.
Update the following: NCPDP Telecommunication Standard, Implementation Guide, Version F6, April 2020 is published, adoption level of N/A and not Federally Required yet. NCPDP has requested this version be named under HIPAA.

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

NCPDP Comment

Add the following:

Type-Implementation Specification

Standard Implementation/Specification- NCPDP SCRIPT Standard Implementation Guide Version 2020101

Standards Process Maturity – Final

Implementation Maturity – Production

Adoption Level – 1

Federally required – No

Cost - $

Test Tool Availability – No

Referral transactions published in the NCPDP SCRIPT Standard Version 2020101.

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

NCPDP Comment

Add Referral transaction to be published in the NCPDP SCRIPT Standard.
Emerging Transaction(s) within NCPDP SCRIPT Standard:
1. Patient Care Service Referral (ServiceReferral)
2. Patient Care Service Documentation (ServiceDocumentation)
3. Response to Request for Patient Care Service Referral (ResponseToReferralRequest)
4. Request for Patient Care Service Referral (RequestForReferral)
5. Response to Patient Care Service Referral (ServiceReferralResponse)
Remove “NCPDP is in the investigative stage of providing a test tool” under Limitations, Dependencies, and Preconditions for Consideration.
Modify Standard/Implementation Specification to “NCPDP SCRIPT Standard, Implementation Guide, Version 2017071

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

NCPDP Comment

Add the following:

Type-Implementation Specification

Standard Implementation/Specification- NCPDP Telecommunication Standard, Implementation Guide, Version F2, March 2018

Standards Process Maturity – Final

Implementation Maturity- Pilot

Adoption Level – 1

Federally Required – No

Cost – $

Test Tool Availability – No.

Type-Implementation Specification

Standard Implementation/Specification- NCPDP SCRIPT Standard, Implementation Guide, Version 201707

Standards Process Maturity – Final

Implementation Maturity- Pilot

Adoption Level – 1

Federally Required – No

Cost – $

Test Tool Availability – Yes.

Limitations, Dependencies, and Preconditions for Consideration
The Telecommunication Standard Implementation Guide Version F2 and SCRIPT Standard Version 2017071 have been requested to be adopted under HIPAA. NCPDP is in the investigative stage of providing a test tool for the Telecommunication Standard NCPDP has a testing tool available for the SCRIPT Standard Version 2017071.

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.