United States Health Information Knowledgebase

 

Member Enrollment


Name:Member Enrollment
Type:Model View
Definition:Member Enrollment Standard and Implementation Guide Version 1 Release 1 - April 1998, Version 1 Release 0 - March 1998 The introduction of managed care concepts to Pharmacy Management Organizations (PMOs) has required various business entities to actively monitor and support the flow of member eligibility information in an accurate and timely manner. The successful transfer and maintenance of this eligibility data provides the foundation for cost containment by limiting claim payment liability. Eligibility information originates from a large variety of sources due to the diversity of companies providing prescription benefits in their medical insurance coverage programs. The record formats, and data elements supplied by the eligibility source provide a unique challenge to PMOs in the maintenance of these enrollment files. The Enrollment Work Group within the National Council for Prescription Drug Programs (NCPDP) assumed the responsibility to develop a standard format for submitting member enrollment information. In 1992, this Work Group assembled participants from all segments of the industry to begin development of an enrollment standard. The objective of this Work Group was to enhance the enrollment verification process and to provide a consistent format in enrollment processing. The result was the release of the NCPDP Member Enrollment Standard (Version 1 Release 0) in early 1994. This Standard was designed in a segment architecture to allow for variation dictated by the business partners using this information. The format is intended to be easily implemented, and provides flexibility for modifications based on new requirements for changes in technology (i.e., ANSI ASC X12 implementation). NCPDP recommends the use of this Standard for the transfer of enrollment information between business entities and enrollment administrators. NCPDP will continue to support the efforts of the Work Group as they continue to enhance this Standard based on industry requirements.
Registration Authority:National Council for Prescription Drug Programs
Status:Recorded
Administrative Attributes
Responsible Organization:National Council for Prescription Drug Programs
Submitting Organization:National Council for Prescription Drug Programs
Steward Organization:National Council for Prescription Drug Programs
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Relationship Organization Item
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utilizes NCPDP Disabled Dependent Coverage Indicator   
utilizes NCPDP Disabled Dependent Covered Through Age   
utilizes NCPDP Effective Date   
utilizes NCPDP Enrollment Relationship Code   
utilizes NCPDP File Type   
utilizes NCPDP First Name   
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utilizes NCPDP Last Name   
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utilizes NCPDP Primary Pharmacy Effective Date   
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utilizes NCPDP Process Begin Date   
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