United States Health Information Knowledgebase

 

Standards

  • |«first
  • «previous
  • 1
  • next»
  • last»|
Results 1 - 20 of 20
SortStandards
SortDefinition
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.
Post Adjudication Standard Supplies detailed drug or utilization claim information after the claim has been adjudicated.
Prescription Transfer Standard To electronically transfer prescription files between pharmacies.
Prior Authorization Transfer Transferring existing prior authorization data between payer/processors when transitioning clients, performing system database or platform changes.
Retiree Drug Subsidy Assists in the automation of summarized drug cost and related data transfer from one processor/pharmacy benefit manager to another processor/pharmacy benefit manager. It allows for the continuation of CMS Retiree Drug Subsidy (RDS) cost data reporting by the receiving entity for a given application ID plan year.
SCRIPT Standard Developed for transmitting prescription information electronically between prescribers, pharmacies, payers, and other entities for new prescriptions, changes of prescriptions, prescription refill requests, prescription fill status notifications, cancellation notifications, relaying of medication history, transactions for long-term care, electronic prior authorization and other transactions.
Specialized Implementation Guide Developed for transmitting information electronically between prescribers, providers, payers, pharmacies and other entities for medication therapy management, census events, central fill functions and other transactions.
Telecommunication Standard Developed to provide a standard format for the electronic submission of third party drug claims and other transactions between pharmacy providers, insurance carriers, third-party administrators, and other responsible parties. The Telecommunication Standard includes transactions for eligibility verification, claim and service billing, predetermination of benefits, prior authorization, information reporting, and controlled substance (general and regulated) transaction exchanges.
Uniform Healthcare Payer Data Standard Used by Client Groups, Pharmacy Benefit Managers (PBMs), Fiscal Agents, Vendors, and Administrative Oversight Organizations and state entities to share pharmacy claim data that is used to support statistical reporting, evaluation of healthcare, and state or regional reporting requirements. This standard should only be used for data submission to a state agency or to a state-sponsored healthcare payer data collection initiative.
Universal Claim Form For Telecommunication 5.1, D.0, and Workers' Compensation/Property and Casualty manual claims processing.
Workers' Compensation/Property & Casualty Universal Claim Form Universal Claim Forms For Telecommunication 5.1, D.0, and Workers' Compensation/Property and Casualty manual claims processing.
  • |«first
  • «previous
  • 1
  • next»
  • last»|
Results 1 - 20 of 20
Scroll To Top