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  • Standards Matrix

    July 2018

    National Council for Prescription Drug Programs 9240 East Raintree Drive Scottsdale, AZ 85260 Phone: (480) 477-1000 Fax: (480) 767-1042 email: ncpdp@ncpdp.org

  • Standards Matrix

    July 2018 Page: 2 National Council for Prescription Drug Programs, Inc.

    Standards Matrix

    Published by: National Council for Prescription Drug Programs

    This work is owned by National Council for Prescription Drug Programs, Inc., 9240 E. Raintree Drive, Scottsdale, AZ 85260, (480) 477-1000, ncpdp@ncpdp.org, and protected by the copyright laws of the United States. 17 U.S.C. 101, et. seq. Permission is given to Council members to copy and use the work or any part thereof in connection with the business purposes of the Council members. The work may not be changed or altered. The work may not be sold, used or exploited for commercial purposes. This permission may be revoked by National Council for Prescription Drug Programs, Inc., at any time. The National Council for Prescription Drugs Programs, Inc. is not responsible for any errors or damage as a result of the use of the work.

    Copyright 2018 NCPDP

    mailto:ncpdp@ncpdp.org

  • Standards Matrix

    July 2018 Page: 3 National Council for Prescription Drug Programs, Inc.

    TABLE OF CONTENTS

    STANDARDS MATRIX .................................................................................................................................................................................................. 5 VERSION IDENTIFICATION SYSTEM ......................................................................................................................................................................... 6

    AUDIT TRANSACTION STANDARD IMPLEMENTATION GUIDE .............................................................................................................................. 8

    BATCH STANDARD IMPLEMENTATION GUIDE ....................................................................................................................................................... 9

    BATCH STANDARD SUBROGATION IMPLEMENTATION GUIDE ......................................................................................................................... 11

    BENEFIT INTEGRATION STANDARD IMPLEMENTATION GUIDE......................................................................................................................... 12

    BILLING UNIT STANDARD IMPLEMENTATION GUIDE .......................................................................................................................................... 13 DATA DICTIONARY .................................................................................................................................................................................................... 15

    EXTERNAL CODE LIST (ECL) ................................................................................................................................................................................... 16

    EMERGENCY TELECOMMUNICATION EXTERNAL CODE LIST VALUE ADDENDUM ............................................................................................................... 22 FINANCIAL INFORMATION REPORTING STANDARD IMPLEMENTATION GUIDE ............................................................................................. 23

    FINANCIAL INFORMATION REPORTING EDITORIAL DOCUMENT ........................................................................................................................................ 23 FORMULARY AND BENEFIT STANDARD IMPLEMENTATION GUIDE ................................................................................................................. 24 FUNCTIONAL PROFILES FOR ELECTRONIC HEALTH RECORD (EHR) SYSTEMS ............................................................................................ 26

    MANUFACTURER REBATE, UTILIZATION, PLAN, FORMULARY, MARKET BASKET, AND RECONCILIATION FLAT FILE STANDARD AND IMPLEMENTATION GUIDE ........................................................................................................................................................................................ 27

    MEDICAID SUBROGATION IMPLEMENTATION GUIDE ......................................................................................................................................... 29

    MEDICAID SUBROGATION VERSION 3.0 QUESTIONS, ANSWERS AND EDITORIAL UPDATES .............................................................................................. 29 MEDICAL REBATE DATA SUBMISSION STANDARD IMPLEMENTATION GUIDE............................................................................................... 30 NCPDP XML SCHEMAS ............................................................................................................................................................................................. 31

    OPERATING RULES ................................................................................................................................................................................................... 32

    OPERATING RULES FOR THE X12 270/271 TRANSACTIONS IN ELECTRONIC PRESCRIBING .............................................................................................. 32 OPERATING RULES FOR CONNECTIVITY ....................................................................................................................................................................... 32 OPERATING RULES FOR THE FORMULARY AND BENEFIT STANDARD .......................................................................................................................................... 32

  • Standards Matrix

    July 2018 Page: 4 National Council for Prescription Drug Programs, Inc.

    PHARMACY AND/OR COMBINATION ID CARD IMPLEMENTATION GUIDE ........................................................................................................ 34

    POST ADJUDICATION STANDARD IMPLEMENTATION GUIDE ............................................................................................................................ 35

    PRESCRIPTION TRANSFER STANDARD IMPLEMENTATION GUIDE .................................................................................................................. 37 PRIOR AUTHORIZATION TRANSFER STANDARD IMPLEMENTATION GUIDE ................................................................................................... 38

    PRODUCT IDENTIFIERS STANDARD IMPLEMENTATION GUIDE......................................................................................................................... 39

    RETIREE DRUG SUBSIDY STANDARD IMPLEMENTATION GUIDE...................................................................................................................... 40

    SCRIPT STANDARD IMPLEMENTATION GUIDE ..................................................................................................................................................... 41

    SCRIPT IMPLEMENTATION RECOMMENDATIONS .......................................................................................................................................................... 41 SIGNATURE LOG ....................................................................................................................................................................................................... 56 SPECIALIZED STANDARD IMPLEMENTATION GUIDE .......................................................................................................................................... 57

    SPECIALTY PHARMACY DATA REPORTING STANDARD IMPLEMENTATION GUIDE ...................................................................................... 65

    STRUCTURED AND CODIFIED SIG FORMAT .......................................................................................................................................................... 66

    TELECOMMUNICATION STANDARD IMPLEMENTATION GUIDE ......................................................................................................................... 67

    TELECOMMUNICATION VERSION D AND ABOVE QUESTIONS, ANSWERS AND EDITORIAL UPDATES ................................................................................... 67 NCPDP EMERGENCY PREPAREDNESS ........................................................................................................................................................................ 68

    UNIFORM HEALTHCARE PAYER DATA STANDARD IMPLEMENTATION GUIDE ............................................................................................... 74

    UNIVERSAL CLAIM FORM ........................................................................................................................................................................................ 75

    MANUAL CLAIM FORMS REFERENCE ............................................................................................................................................................................ 75 UNIVERSAL CLAIM FORM PURCHASE ........................................................................................................................................................................... 75

    XML STANDARD ........................................................................................................................................................................................................ 78

    APPENDIX A. STANDARDS/GUIDES/FORMATS NO LONGER MAINTAINED OR SUPPORTED ........................................................................ 81

    NCPD

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