United States Health Information Knowledgebase



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Audit Transaction Standard Defines the record layout for batch audit transactions between Auditors and Providers to support electronic audit transactions that facilitate requests, responses, and final outcomes transmissions for both "Desk Top" claim audits and for in-store audit notices. This standard addresses the types of communication between Auditors and Providers and allows that communication to occur in an electronic environment rather than paper-based.
Batch Standard Uses the functionality, syntax, formatting, data set, and rules of the Telecommunication Standard to "wrap" in a detail record for an implementer to "code once". A batch header and trailer are included to support a batch method of delivery.
Billing Unit Standard Provides a consistent and well-defined billing unit for use in pharmacy transactions. This results in time savings and accuracy in billing and reimbursement.
Financial Information Reporting Standard Provides a standardized format for the exchange of accumulated financial information between Medicare Part D plans.
Formulary & Benefit Standard Provides a standard means for pharmacy benefit payers (including health plans and Pharmacy Benefit Managers) to communicate formulary and benefit information to prescribers via technology vendor systems.
Health Care ID Card The purpose of The NCPDP Guide is to provide parameters for utilizing an ANSI approved health care ID card standard which clearly and consistently defines the information and format required by the pharmacy provider.
Manufacturer Rebate Standard Supports the electronic submission of rebate information from Pharmacy Management Organizations (PMOs) to Pharmaceutical Industry Contracting Organizations (PICOs).
Medicaid Subrogation Provides guidelines for the process whereby a Medicaid agency can communicate to a processor for reimbursement.
Medical Rebate Data Submission Standard Provides a standardized format for health plans' rebate submissions to multiple manufacturers throughout the industry.
Operating Rules Provides consistent implementation of necessary business rules and guidelines for the electronic exchange of information used in pharmacy and electronic prescribing industry exchanges for NCPDP standards and the ASC X12 standards transactions that are not defined by a standard or its implementation specifications as adopted.
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