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picture1_Technology Ppt 69087 | Ncpdp Ncvhs 201012 Operating Rules Testimony


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File: Technology Ppt 69087 | Ncpdp Ncvhs 201012 Operating Rules Testimony
what is ncpdp an ansi accredited standards development organization provides a forum and marketplace for a diverse membership focused on health care and pharmacy business solutions a member driven organization ...

icon picture PPT Filetype Power Point PPT | Posted on 29 Aug 2022 | 3 years ago
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                                    What is NCPDP?
          An ANSI-accredited standards development organization.
          Provides a forum and marketplace for a diverse membership focused 
           on health care and pharmacy business solutions.
          A member driven organization that has been named in various 
           government legislation and rulings, such as HIPAA and the Medicare 
           Part D Regulation.
          One of several Standards Development Organizations (SDOs) involved 
           in Healthcare Information Technology and Standardization.
          Focus on pharmacy services, and has the highest member 
           representation from the pharmacy services sector of healthcare.
                                                                               2
                   HIPAA Eligibility and Claim Status
          NCPDP:
            Telecommunication Standard Implementation Guide Version 
             D.0
            Batch Standard Implementation Guide Version 1.2
          ASC X12:
            ASC X12 270/271 Technical Report Type 3
            ASC X12 276/277 Technical Report Type 3
          Note: pharmacy industry utilizes the ASC X12 835 (remittance 
           advice), 834 (enrollment) and the 270/271 (eligibility) is used as 
           part of electronic prescribing.
          Note: pharmacy industry does not use the claim status 
           transaction.
                                                             3
                     Operating Rules Definition
      (1) DEFINITION OF OPERATING RULES.—Section 1171 of the Social 
          Security Act (42 U.S.C. 1320d) is amended by adding at the end 
          the following:
      ‘‘(9) OPERATING RULES.—The term ‘operating rules’ means the 
          necessary business rules and guidelines for the electronic 
          exchange of information that are not defined by a standard or 
          its implementation specifications as adopted for purposes of 
          this part.’’
      Points from the regulation:
         Recognized that business rules and guidelines may already be 
          present in the implementation specifications.
         Operating rules may cover exchange not already defined in the 
          implementation specifications.
         SDOs govern the data content of the transmissions and the business 
          rules and reference documents required to support the data content. 
         Operating Rules cannot add, modify or remove requirements defined 
          in the implementation specifications.
                                                         4
               Operating Rules Recommendations
      Publication of documents
         Operating rules are impacted by implementation specifications.
         Operating rules may also be updated between implementation 
          specifications to satisfy appropriate business requirements that 
          would not have an impact on the implementation specifications.
      Operating Rule entities must collaborate where possible.
         NCPDP, CORE and other named entities will continue to 
          collaborate.
      Operating Rule entities must use the existing process to bring 
       regulatory requests forward – the industry understands this 
       process.
         Submission of new versions of operating rules to DSMO.
         DSMO recommends new versions of operating rules to NCVHS.
         NCVHS recommends new versions of operating rules to the 
          Secretary of HHS.
                                                  5
                Concerns that must be addressed
     The charge to operating rules entities was to address eligibility and 
     claim status transactions.
     
      Additional topics have not been vetted fully by the entire industry 
     and therefore must not be imposed on the entire industry.
           Connectivity
           Response time
           System availability
           “Companion guides”
     
      Difference identified
           Acknowledgements
     
      Additional topics to be addressed by HHS
           Safe harbor
           Certification
                                                     6
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...What is ncpdp an ansi accredited standards development organization provides a forum and marketplace for diverse membership focused on health care pharmacy business solutions member driven that has been named in various government legislation rulings such as hipaa the medicare part d regulation one of several organizations sdos involved healthcare information technology standardization focus services highest representation from sector eligibility claim status telecommunication standard implementation guide version batch asc x technical report type note industry utilizes remittance advice enrollment used electronic prescribing does not use transaction operating rules definition section social security act u s c amended by adding at end following term means necessary guidelines exchange are defined or its specifications adopted purposes this points recognized may already be present cover govern data content transmissions reference documents required to support cannot add modify remove re...

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