NCPDP Announces Several Changes for 2012
NCPA was represented by staff attending the National Council for Prescription Drug Programs Workgroup meetings, and learned that final verbiage for the Standardized Notice for information patients of their exception and appeals process is not expected to be released until the end of November, and the expectation is 90 days for compliance from the finalized date, not Jan. 1, 2012 as previously understood. NCPA will confirm this information and seek clarification on whether the plans are expected to provide this language or there will be a section on the Centers for Medicare & Medicaid Services (CMS) website for providers to access the language and print out on their own. This is a new requirement that all pharmacies must follow by distributing a notice directly to a beneficiary when their prescription cannot be filled. In the past the requirement was to post the notice in the pharmacy.
Also, all Part D prescriptions will require a unique BIN/PCN/RxID/Group Number in 2012. These data elements are referred to as "4Rx" data that plans must submit to CMS effective Jan. 1, 2012. However there is a delay until April 1, 2012 to allow time for pharmacies to work with beneficiaries who may be using new cards. Pharmacies will in many instances need to input more beneficiary card ID information into their systems for claim adjudication than in the past. Plans may begin the lockdown on these claims earlier with hard edits. In the event of a reject for invalid 4Rx data, the pharmacy is advised to check the OHI (other health information) field for clarification information, the plan may be able to provide the correct information, or the pharmacy may submit an E1 query to verify beneficiary information.