Change Request Detail
Type of Request
Health Care Eligibility Requests or Responses
DSMO Process Completed
Business Reason
[The following is a wild and crazy idea to improve the clinical effectiveness of a health care encounter.]   In addition to the 'usual' information returned in response to a health care eligibility request, also return a list of all medications dispensed that the health plan and its Pharmacy Benefit Managers (PBM) and other business associates have in their files.  For medications dispensed by retail pharmacies, send both a textual description of each medication and the corresponding NDC value.  For medications dispensed from other than retail pharmacies, send a textual description plus a code set name qualifier (e.g., Medispan, First Data Bank) and the applicable drug code from that code set.  At this stage of health care, any such information is better than none at all -- which is often the present situation.
Modify the 271 transaction Standard as necessary and Type 3 Technical Reports to ensure that an unlimited number of medication description, medication code set identification qualifier, and medication code value triads may be sent.
DSMO Category
Denied. The current eligibility transaction is not appropriate for this purpose. NCPDP SCRIPT Standard (V8.0 and higher) contains the Medication History transaction set.  Using these transactions, any entity (prescriber, pharmacy, etc.) may request the electronic medication history of a patient.  The electronic response received may include detailed prescription data from  pharmacies, PBMs, payers, or other sources dependent upon the specific implementation and agreements between trading partners. Using a core Medication History transaction set having extensive industry experience and recommended by NCVHS, NCPDP added these new transactions to the SCRIPT Standard in 2005.  These Medication History transaction standards are also being studied in the 2006 CMS e-Prescribing Pilots.
Appeal Recommendation