Change Request Detail
Type of Request
Retail Pharmacy Claim
DSMO Process Completed
Business Reason
The NCPDP membership is requesting a new version of the Telecommunication and Batch Standard be named in HIPAA. The Telecommunication Standard Implementation Guide is version D. The Batch Standard Implementation Guide is version 1.2, which supports Telecommunication version D in a batch mode.

The Telecommunication Standard Implementation Guide supports the following processes
1.    Eligibility Verification
2.    Claim
3.    Service
4.    Information Reporting
5.    Prior Authorization
6.    Predetermination of Benefits

NCPDPs SNIP Committee is working with WEDI on the Benefit Analysis Survey. This committee is also planning to provide educational webcasts for the industry.

Changes from version 5.1 to version D are provided under separate cover. Changes include the addition of fields to support Medicare Part D functionality, enhancements to coordination of benefits processing, more guidance for balancing and pricing support as business needs have evolved, and the addition of mandatory/situational designations per the HIPAA Privacy regulation.
Request the DSMO approve this change request and thus begin the process for a new version to be named in HIPAA.
DSMO Category
Approve.  The DSMO is supportive of the work done by NCPDP to update this adopted standard.  We are aware that the new version includes changes that will support business needs that have evolved since the adoption of the 5.1 version. In addition, the DSMO encourages quick adoption of this updated standard, which could occur if the streamlined process, as identified by the standards development organizations and WEDI, for modifications to standards is adopted and followed.  The DSMO acknowledges that the maintenance of administrative transaction standards is an evolving process and looks forward to continuing to work on improving the standards and the business processes they support.
Appeal Recommendation