Payer Name: Maryland Medical Assistance Program. Medicaid
|
|
- Allan Stevenson
- 8 years ago
- Views:
Transcription
1 aryland edical Assistance Program edicaid Request Payer Sheet ** Start of Request (B2) Payer Sheet Template** GENERAL INFORATION Payer Name: aryland edical Assistance Program Date: January 1, 2Ø12 Plan Name/Group Name: aryland Department of Health and ental BIN: 61ØØ84 Hygiene Plan Name/Group Name: aryland Department of Health and ental BIN: 61ØØ84 Hygiene (test) PCN: DRDPROD = Production PCN: DRDACCP = Test FIELD LEGEND FOR COLUNS Payer Column Value Explanation Column ANDATORY The Field is mandatory for the Segment in the designated Transaction. No REQUIRED R The Field has been designated with the situation of Required for the Segment in the designated Transaction. QUALIFIED REQUIREENT RW Required when. The situations designated have qualifications for usage ( Required if x, Not required if y ). No Yes Question What is your reversal window? (If transaction is billed today what is the timeframe for reversal to be submitted?) Answer 365 days CLAI REVERSAL TRANSACTION The following lists the segments and fields in a Transaction for the NCPDP Telecommunication Standard Implementation Guide Version D.Ø. Transaction Header Segment Questions Check Source of certification IDs required in Software Vendor/Certification ID (11Ø-AK) is Not used Transaction Header Segment 1Ø1-A1 BIN NUBER Ø2-A2 VERSION/RELEASE NUBER DØ 1Ø3-A3 TRANSACTION CODE B2 1Ø4-A4 PROCESSOR CONTROL NUBER DRDPROD = Production DRDACCP = Test. 1Ø9-A9 TRANSACTION 1 = One Occurrence 2Ø2-B2 SERVICE PROVIDER ID Ø1 = National Provider Identifier 2Ø1-B1 SERVICE PROVIDER ID NPI Number 4Ø1-D1 DATE OF SERVICE CCYYDD 11Ø-AK SOFTWAREVENDOR/CERTIFICATION ID This will be provided by the provider's software vender If no number is supplied, populate with zeros Insurance Segment Questions Check Insurance Segment Segment Identification (111-A) = Ø4
2 3Ø2-C2 CARDHOLDER ID Recipient s 11digits edicaid ID 3Ø1-C1 GROUP ID DEDICAID R Claim Segment Questions Check Claim Segment Segment Identification (111-A) = Ø7 455-E PRESCRIPTION/SERVICE REFERENCE NUBER 1 = R Billing For Transaction Code of B2, in the Claim Segment, the Prescription/Service Reference Number Qualifier (455-E) is 1 (Rx Billing). 4Ø2-D2 PRESCRIPTION/SERVICE REFERENCE Number assigned by pharmacy NUBER 436-E1 PRODUCT/SERVICE ID Ø3 = NDC 4Ø7-D7 PRODUCT/SERVICE ID NDC Number 4Ø3-D3 FILL NUBER Ø = Original Dispensing 1-99 = Number of refills 3Ø8-C8 OTHER COVERAGE CODE Ø=Not Specified 1=No other Coverage Identified 2=Other coverage exists-payment collected 3=Other coverage exists-this claim not covered 4=Other coverage exists-payment not collected R RW ** End of Request (B2) Payer Sheet Template** Imp Guide: Required if needed for reversals when multiple fills of the same Prescription/Service Reference Number (4Ø2- D2) occur on the same day. Imp Guide: Required if needed by receiver to match the claim that is being reversed. RESPONSE CLAI REVERSAL PAYER SHEET TEPLATE CLAI REVERSAL ACCEPTED/APPROVED RESPONSE ** Start of Response (B2) Payer Sheet Template** GENERAL INFORATION Payer Name: aryland edical Assistance Program Date: January 1, 2Ø12 Plan Name/Group Name: aryland Department of Health and ental BIN: 61ØØ84 Hygiene Plan Name/Group Name: aryland Department of Health and ental BIN: 61ØØ84 Hygiene (test) PCN: DRDPROD = Production PCN: DRDACCP = Test CLAI REVERSAL ACCEPTED/APPROVED RESPONSE The following lists the segments and fields in a response (Approved) Transaction for the NCPDP Telecommunication Standard Implementation Guide Version D.Ø. Questions Check 1Ø2-A2 VERSION/RELEASE NUBER DØ 1Ø3-A3 TRANSACTION CODE B2 1Ø9-A9 TRANSACTION 1 = One Occurrence 5Ø1-F1 HEADER RESPONSE STATUS A = Accepted 2Ø2-B2 SERVICE PROVIDER ID Ø1 = National Provider Identifier 2Ø1-B1 SERVICE PROVIDER ID NPI Number
3 4Ø1-D1 DATE OF SERVICE CCYYDD Questions Check Segment Identification (111-A) = AN TRANSACTION RESPONSE STATUS A = Approved 5Ø3-F3 AUTHORIZATION NUBER 17-digit D TCN R 13Ø-UF ADDITIONAL ESSAGE INFORATION aximum count of 25. RW Required if Additional essage Information 132-UH ADDITIONAL ESSAGE INFORATION RW Required if Additional essage Information 526-FQ ADDITIONAL ESSAGE INFORATION RW Required when additional text is needed for clarification or detail. 131-UG ADDITIONAL ESSAGE INFORATION RW Required if and only if current repetition of Additional essage Information (526-FQ) is used, another populated repetition of Additional essage Information (526-FQ) follows it, and the text of the following message is a continuation of the current. Response Claim Segment Questions Check Response Claim Segment Segment Identification (111-A) = E PRESCRIPTION/SERVICE REFERENCE NUBER 1 = RxBilling For Transaction Code of B2, in the Response Claim Segment, the Prescription/Service Reference Number Qualifier (455-E) is 1 (Rx Billing). 4Ø2-D2 PRESCRIPTION/SERVICE REFERENCE NUBER Number assigned by the pharmacy CLAI REVERSAL ACCEPTED/REJECTED RESPONSE Questions Check - Accepted/Rejected 1Ø2-A2 VERSION/RELEASE NUBER DØ 1Ø3-A3 TRANSACTION CODE B2 1Ø9-A9 TRANSACTION 1 = One Occurrence 5Ø1-F1 HEADER RESPONSE STATUS A = Accepted 2Ø2-B2 SERVICE PROVIDER ID Ø1 = National Provider Identifier 2Ø1-B1 SERVICE PROVIDER ID NPI Number 4Ø1-D1 DATE OF SERVICE CCYYDD Accepted/Rejected Response essage Segment Questions Check - Accepted/Rejected This Segment is situational Segment sent if required for reject clarification
4 Response essage Segment Segment Identification (111-A) = 2Ø 5Ø4-F4 ESSAGE RW Required if text is needed for clarification or detail. Questions Check - Accepted/Rejected Accepted/Rejected Segment Identification (111-A) = AN TRANSACTION RESPONSE STATUS R = Reject 5Ø3-F3 AUTHORIZATION NUBER R 51Ø-FA REJECT aximum count of 5. R 511-FB REJECT CODE R 546-4F REJECT FIELD OCCURRENCE INDICATOR RW Required if a repeating field is in error, to identify repeating field occurrence. 13Ø-UF ADDITIONAL ESSAGE INFORATION aximum count of 25. RW Imp Guide: Required if Additional essage Information 132-UH ADDITIONAL ESSAGE INFORATION RW Required if Additional essage Information 526-FQ ADDITIONAL ESSAGE INFORATION RW Required when additional text is needed for clarification or detail. 131-UG ADDITIONAL ESSAGE INFORATION Response Claim Segment Questions Check - Accepted/Rejected RW Imp Guide: Required if and only if current repetition of Additional essage Information (526-FQ) is used, another populated repetition of Additional essage Information (526-FQ) follows it, and the text of the following message is a continuation of the current. Response Claim Segment Accepted/Rejected Segment Identification (111-A) = E PRESCRIPTION/SERVICE REFERENCE NUBER 1 = Rx Billing For Transaction Code of B2, in the Response Claim Segment, the Prescription/Service Reference Number Qualifier (455-E) is 1 (Rx Billing). 4Ø2-D2 PRESCRIPTION/SERVICE REFERENCE NUBER Number assigned by the pharmacy
5 CLAI REVERSAL REJECTED/REJECTED RESPONSE Questions Check - Rejected/Rejected 1Ø2-A2 VERSION/RELEASE NUBER DØ 1Ø3-A3 TRANSACTION CODE B2 1Ø9-A9 TRANSACTION 1 = One Occurrence 5Ø1-F1 HEADER RESPONSE STATUS R = Rejected 2Ø2-B2 SERVICE PROVIDER ID Ø1 = National Provider Identifier 2Ø1-B1 SERVICE PROVIDER ID NPI Number 4Ø1-D1 DATE OF SERVICE CCYYDD Rejected/Rejected Response essage Segment Questions Check Rejected/Rejected This Segment is situational Used if necessary to elaborate on Header level rejects. Response essage Segment Segment Identification (111-A) = 2Ø 5Ø4-F4 ESSAGE RW Required if text is needed for clarification or detail. Questions Check - Rejected/Rejected Rejected/Rejected Segment Identification (111-A) = AN TRANSACTION RESPONSE STATUS R = Reject 5Ø3-F3 AUTHORIZATION NUBER R 51Ø-FA REJECT aximum count of 5. R 511-FB REJECT CODE R 546-4F REJECT FIELD OCCURRENCE INDICATOR RW Required if a repeating field is in error, to identify repeating field occurrence. 13Ø-UF ADDITIONAL ESSAGE INFORATION aximum count of 25. RW Required if Additional essage Information 132-UH ADDITIONAL ESSAGE INFORATION RW Required if Additional essage Information 526-FQ ADDITIONAL ESSAGE INFORATION RW Imp Guide: Required when additional text is needed for clarification or detail. 131-UG ADDITIONAL ESSAGE INFORATION RW Imp Guide: Required if and only if current repetition of Additional essage Information (526-FQ) is used, another populated repetition of Additional essage Information (526-FQ) follows it, and the text of the following message is a continuation of the current. ** End of (B2) Response Payer Sheet Template**
Payer Name: Maryland Medical Assistance Program ADAP
aryland edical Assistance Program ADAP Request Payer Sheet ** Start of Request (B2) Payer Sheet Template** GENERAL INFORATION Payer Name: aryland edical Assistance Program Date: January 1, 2Ø12 Plan Name/Group
More informationUTAH MEDICAID NCPDP VERSION D.Ø PAYER SHEET
UTAH EDICAID NCPDP VERSION D.Ø PAYER SHEET REQUEST CLAI BILLING/CLAI REBILL ** Start of Request (B1/B3) Payer Sheet ** GENERAL INFORATION Payer Name: Utah Department of Health Date: September 26, 2Ø13
More informationTransaction Header Segment Claim Billing/Claim Rebill Field # NCPDP Field Name Value Payer Payer Situation
United States Department of Labor Division of Coal ine Worker s Compensation (Federal Black Lung Program) Request (B1/B3) Payer Sheet GENERAL INFORATION Payer Name: Department of Labor Date: September
More informationCOLORADO MEDICAL ASSISTANCE PROGRAM
COLORADO EDICAL ASSISTANCE PROGRA ** Start of Request (B1/B3) Payer Sheet Template** GENERAL INFORATION Payer Name: Colorado edical Assistance Program Date: September 22, 2011 Plan Name/Group Name: Colorado
More informationDepartment of Labor Division of Federal Employees Compensation Request Claim Billing/Claim Rebill (B1/B3) Payer Sheet
Department of Labor Division of Federal Employees Compensation Request (B1/B3) Payer Sheet GENERAL INFORATION Payer Name: Department of Labor Date: September 23, 2011 Plan Name/Group Name: Division of
More informationForwardHealth Payer Sheet: National Council for Prescription Drug Programs (NCPDP) Version D.Ø
ForwardHealth Payer Sheet: National Council for Prescription Drug Programs (NCPDP) Version D.Ø P-ØØ272 (09/15) TABLE OF CONTENTS INTRODUCTION... 3 GENERAL INFORATION... 3 Transactions Supported... 3 PAYER
More informationOTHER TRANSACTIONS SUPPORTED Payer: Please list each transaction supported with the segments, fields, and pertinent information on each transaction.
NCPDP VERSION D CLAIM BILLING/CLAIM REBILL REQUEST CLAIM BILLING/CLAIM REBILL PAYER SHEET ** Start of Request (B1/B3) Payer Sheet ** GENERAL INFORMATION Payer Name: Gateway Health Plan MA-PD Date: 11/15/2012
More informationREQUEST CLAIM BILLING/CLAIM REBILL PAYER SHEET ** Start of Request Claim Billing/Claim Rebill (B1/B3) Payer Sheet Template**
REQUEST CLAIM BILLING/CLAIM REBILL PAYER SHEET ** Start of Request (B1/B3) Payer Sheet Template** GENERAL INFORMATION Payer Name: CatalystRx Date: 01/01/2012 Plan Name/Group Name: Commercial BIN: 603286
More informationVersion 1.Ø for 2Ø15
2Ø15 Payer Sheet NCPDP Version D.Ø Version 1.Ø for 2Ø15 Release Date: December 1, 2Ø14 Effective Date: January 1, 2Ø15 Contents GENERAL INFORATION... 3 BIN INFORATION... 3 PCN LIST FOR BIN Ø17639... 3
More informationDepartment of Labor Division of Federal Employees Compensation Request Claim Billing/Claim Rebill (B1/B3) Payer Sheet
Department of Labor Request (B1/B3) Payer Sheet GENERAL INFORATION Payer Name: Department of Labor Date: September 23, 2011 Plan Name/Group Name: Division of Federal Employees BIN: 61ØØ84 PCN: DDPROD =
More informationREQUEST CLAIM BILLING/CLAIM REBILL PAYER SHEET ** Start of Request Claim Billing/Claim Rebill (B1/B3) Payer Sheet **
NCPDP VERSION D CLAIM BILLING/CLAIM REBILL REQUEST CLAIM BILLING/CLAIM REBILL PAYER SHEET ** Start of Request (B1/B3) Payer Sheet ** GENERAL INFORMATION Payer Name: US Script Date: 05/01/2013 Plan Name/Group
More informationPayer Sheet. Medicare Part D Other Payer Patient Responsibility
Payer Sheet Medicare Part D Other Payer Patient Responsibility Table of Contents HIGHLIGHTS Updates, Changes & Reminders... 3 PART 1: GENERAL INFORMATION... 4 Pharmacy Help Desk Information... 4 PART 2:
More informationHIV UNINSURED CARE PROGRAMS AIDS DRUG ASSISTANCE PROGRAM (ADAP) PHARMACY PROVIDER MANUAL
NEW YORK STATE DEPARTMENT OF HEALTH AIDS INSTITUTE HIV UNINSURED CARE PROGRAMS AIDS DRUG ASSISTANCE PROGRAM (ADAP) PHARMACY PROVIDER MANUAL HIV Uninsured Care Programs Empire Station P.O. Box 2052 Albany,
More informationD.0 General Information... 13
Pharmacy Billing anual Pharmacy Requirements and Benefits...1 1990 OBRA Rebate Program... 1 Prior Authorization Request (PAR) Process... 1 edications Requiring a PAR... 2 Guidelines Used by the Department
More informationMedicare Part D Long-Term Care Automated Override Codes... 24. Medicare Part D Update Use of Prescription Origin Code... 25
Payer heet Table of Contents HIGHLIGHT Updates, Changes & Reminders... 3 PART 1: GENERAL INFORATION... 4 PART 2: BILLING TRANACTION / EGENT AND FIELD... 5 PART 3: REVERAL TRANACTION... 12 PART 4: PAID
More informationDC Medicaid Medical Assistance Programs Request Claim Billing/Claim Rebill (B1/B3) Payer Sheet
DC edicaid edical Assistance Programs Request (B1/B3) Payer Sheet GENERAL INFORATION Payer Name: DC edical Assistance Administration Date: Date of Publication of this Template Plan Name/Group Name: DC
More informationMaryland AIDS Drug Assistance Program (MADAP)
aryland AIDS Drug Assistance Program ADAP equest (B1/B3) Payer Sheet GENEAL INFOATION Payer Name: aryland edical Assistance Program Date: September 19, 2011 Plan Name/Group Name: aryland AIDS Drug Assistance
More informationemedny New York State Department Of Companion Guide Version Number: 1.2 May 22, 2014 Health Insurance Programs (OHIP)
New York State Department of Health (NYS DOH) Office of Health Insurance Programs (OHIP) New York State Department New of Health York (NYS State DOH) Office of Health Insurance Department Programs (OHIP)
More informationMedImpact D.0 Payer Sheet Commercial Processing Publication Date: October 7, 2014
TABLE OF CONTENTS 1. NCPDP VERSION D CLAI BILLING... 2 1.1 GENERAL INFORATION FOR PHARACY PROCESSING... 2 1.2 PROCESSING NOTES:... 2 1.2.1 Reversals... 2 1.2.2 Reversals of COB claims... 3 1.2.3 Transaction
More information2013 Pharmacy Manual
2013 Pharmacy anual www.americanhealthcare.com memberservices@americanhealthcare.com Office: 1-800-872-8276 2217 Plaza Drive, Rocklin, CA 95765 Fax: 1-916-773-7210 Office 1 800 872 8276 Fax 1 877 579 4701
More informationCATAMARAN NON MEDICARE PART D PAYER SHEET NCPDP VERSION D.Ø
Catamaran 1600 McConnor Parkway Schaumburg, IL 60173-6801 CATAMARAN NON MEDICARE PART D PAYER SHEET NCPDP VERSION DØ REQUEST CLAIM BILLING/CLAIM REBILL Payer Name: Catamaran Plan Name/Group Name: Catamaran
More informationRI Medical Assistance Payer Sheet
Mandatory Name Definition of Transaction Header Segment - Version D.0 1Ø1-A1 BIN NUMBER Card Issuer ID or Bank ID Number used for network routing. M 6 61Ø471 Add Value: DØ=Version D.Ø 1Ø2-A2 VERSION/ RELEASE
More informationMedImpact D.0 Payer Sheet Medicare Part D Publication Date November 1, 2011
TABLE OF CONTENTS 1. NCPDP VERSION D CLAIM BILLING...2 1.1 REQUEST CLAIM BILLING...2 GENERAL INFORMATION FOR PHARMACY PROCESSING...2 1.1.1 EMERGENCY PREPAREDNESS:...14 1.1.2 VACCINE BILLING REQUIREMENTS...15
More informationDepartment of Health Care Services CA-MMIS. National Council for Prescription Drug Programs (NCPDP) D.0. Real-Time Tes ting V 2.0
Department of Health Care Services CA-MMIS National Council for Prescription Drug Programs (NCPDP) D.0 Real-Time Tes ting V 2.0 06/15/2012 2012 Xerox Corporation and ACS, A Xerox Company. All rights reserved.
More informationSubmission Error Codes
Submission Error s Provider Manual Appendix B Table of Contents HIGHLIGHTS Updates, Changes & Reminders... 2 PART 1: GENERAL INFORMATION... 3 Pharmacy Help Desk Information... 3 PART 2: Submission Error
More informationMedImpact D.0 Payer Sheet Medicare Part D Publication Date: September 21, 2015 1. NCPDP VERSION D CLAIM BILLING...2
TABLE OF CONTENTS 1. NCPDP VERSION D CLAIM BILLING...2 1.1 GENERAL INFORMATION FOR PHARMACY PROCESSING... 2 1.2 PROCESSING NOTES:... 2 1.2.1 Reversals... 2 1.2.2 Reversals of COB claims... 2 1.2.3 Transaction
More informationMedImpact D.0 Payer Sheet Medicare Part D Publication Date: October 7, 2014
TABLE OF CONTENTS 1. NCPDP VERSION D CLAIM BILLING... 2 1.1 GENERAL INFORMATION FOR PHARMACY PROCESSING... 2 1.2 PROCESSING NOTES:... 2 1.2.1 Reversals... 2 1.2.2 Reversals of COB claims... 2 1.2.3 Transaction
More informationSPARK-ITS New Mexico Medicaid D.0 MCO Payer Sheet B1-B3
SPAK-ITS New exico edicaid D.0 CO Payer Sheet B1-B3 Expert ode (E) Project anagement ethodology October 1, 2014 Version 1.0 2011-2012 Xerox Corporation, Xerox and Xerox and Design are trademarks of Xerox
More informationPHARMACY PROVIDER MANUAL
PHARMACY PROVIDER MANUAL TABLE OF CONTENTS 1. INTRODUCTION 3 1.1 About this Manual 4 2. Key Terms 4 3. Contact Information 5 3.1 Telephone and Fax Numbers 5 3.2 Mailing Address 5 3.3 Provider Enrollment
More informationExpress Scripts NCPDP Version D.0 Payer Sheet Commercial
IPOTANT NOTE: Express Scripts only accepts NCPDP Version D.0 electronic transactions. This documentation is to be used for programming the fields and values Express Scripts will accept when processing
More informationPayor Sheet for Medicare Part D/ PDP and MA-PD
Payor Specification Sheet for MEDICARE PART D/PDP AND MA-PD PRIME THERAPEUTICS LLC CLIENTS JANUARY 1, 2006 (Page 1 of 8) BIN: PCN: See BINs on page 2 (in bold red type) See PCNs on page 2 (in bold red
More informationRequired field: Ø1=Patient response. 3Ø7-C7 Place of Service Code identifying the location of the patient when Required field: Required.
2.3.2 NCPDP D.0 Layouts Request Segments Data elements not listed in the table below are not required by the DMAP. Transaction Header Segment - Request 1Ø1-A1 Bin Number Card Issuer ID or Bank ID Number
More informationNational Government Services, Inc. Common Electronic Data Interchange
COON ELECTONIC DATA INTECHANGE COPANION DOCUENT National Government Services, Inc. Common Electronic Data Interchange Companion Guide Communications/Connectivity Information Instructions related to Transactions
More informationPharmacy Provider Manual
Pharmacy Provider Manual 1 1.0 General Overview 1.1 Confidentiality Statement 1.2 Pharmacy Requirements 2.0 Contact Information 2.1 SelectHealth Pharmacy Help Desk 2.2 SelectHealth Member Services 2.3
More informationAETNA NCPDP D.Ø CLAIM BILLING (B1) MEDICARE PAYER SHEET IMPLEMENTATION GUIDE FOR VERSION D.Ø VERSION 5.Ø
AETNA NCPDP D.Ø CLAI BILLING (B1) EDICAE PAYE SHEET IPLEENTATION GUIDE FO VESION D.Ø VESION 5.Ø April 2013 TABLE OF CONTENTS 1. NCPDP VESION D CLAI BILLING EDICAE... 3 1.1 EQUEST CLAI BILLING EDICAE PAYE
More informationNCPDP Version D.0 Payer Sheet
NCPDP Version D.0 Payer heet Payer Name: EH Date: 9/15/2011 Plan Name/Group Name: ALL PLAN BIN: 004527 PCN: eho udl Plan Name/Group Name: ALL PLAN BIN: 003241 PCN: Plan Name/Group Name: ALL Walgreen s
More informationNCPDP Batch Standard
NCPDP Batch Standard To implement the Batch Standard for HIPAA, the Batch Standard Implementation Guide Version 1.2 is used. Since the Batch Standard uses the data elements, parsing routine and many of
More informationTable of Contents. 2 P a g e
Table of Contents Introduction... 3 Important Contact Information... 3 Pharmacy Rights... 3 Claims Adjudication... 3 Reversals... 4 Required Data Fields... 4 Identification cards... 4 Required Identification
More informationSummary of New Plans and Plan Sponsor changes Effective January 1, 2011
Medco Health Solutions, Inc. 100 Parsons Pond Drive Franklin Lakes, NJ 07417 www.medco.com/rph Summary of New Plans and Plan Sponsor changes Effective January 1, 2011 New Plan Sponsors Plan sponsor: See
More informationBest Practice Recommendation for
Best Practice Recommendation for Exchanging & Processing about Pharmacy Benefit Management Version 091714a Issue Date Version Explanation Table of Contents Improvement Opportunity:... 1 Summary of Recommendation:...
More information34ØB INFORMATION EXCHANGE
34ØB INFORMATION EXCHANGE REFERENCE GUIDE VERSION 1.Ø The NCPDP 34ØB Information Exchange Reference Guide was developed to meet the industry needs for electronic communication between trading partners
More informationMedicare s Limited Income Newly Eligible Transition (NET) Program. Four Steps for Pharmacy Providers
Medicare s Limited Income Newly Eligible Transition (NET) Program Four Steps for Pharmacy Providers The Limited Income NET Program (or LI NET) is designed to eliminate any gaps in coverage for low-income
More informationPROPOSED REGULATION OF THE STATE BOARD OF PHARMACY. LCB File No. R047-15. September 15, 2015
PROPOSED REGULATION OF THE STATE BOARD OF PHARMACY LCB File No. R047-15 September 15, 2015 EXPLANATION Matter in italics is new; matter in brackets [omitted material] is material to be omitted. AUTHORITY:
More informationDear Valued Customer,
Dear Valued Customer, Welcome to the comprehensive one-stop pharmacy management solution. The Digital Rx Pharmacy Management System features include: Retail Pharmacy module; Long-Term Care; Retail Point-of-Sale;
More informationPHARMACY PROCEDURES MANUAL
PHARMACY PROCEDURES MANUAL OCTOBER 2007 IdealScripts is committed to providing the best quality service possible. Please follow the information provided in this manual to ensure that submitted claims are
More informationPHARMACY MANUAL. WHP Health Initiatives, Inc. 2275 Half Day Road, Suite 250 Bannockburn, IL 60015
PHARMACY MANUAL WHP Health Initiatives, Inc. 2275 Half Day Road, Suite 250 Bannockburn, IL 60015 Welcome WHP Health Initiatives, Inc. ( WHI ) is pleased to welcome you to our network of participating pharmacies.
More informationPOS Helpdesk Operational Procedure
POS Helpdesk Operational Procedure Purpose: To describe the tools and scenarios associated with IME Pharmacy Point of Sale (POS) Help Desk operations. Identification of Roles: Pharmacy Point of Sale (POS)
More informationNCPDP Reject Error Codes
NCPDP Reject Error Codes This page contains NCPDP Reject Error Codes and descriptions as well as the corresponding PROMISe Internal Error Status Codes. Although the complete crosswalk is provided for informational
More informationPharmacy Point of Sale
RESOURCE AND PATIENT MANAGEMENT SYSTEM Pharmacy Point of Sale (ABSP) Version 1.0 Patch 42 Office of Information Technology (OIT) Division of Information Resource Management Albuquerque, New Mexico Table
More informationManual of Instructions
NEW YORK STATE DEPARTMENT OF HEALTH OFFICIAL NEW YORK STATE PRESCRIPTION PROGRAM ELECTRONIC DATA TRANSMISSION Manual of Instructions New York State Department of Health Bureau of Narcotic Enforcement 433
More informationLouisiana Medicaid Management Information Systems (LA MMIS) Vendor Specifications Document for the Point of Sale (POS) System
Louisiana Medicaid Management Information Systems (LA MMIS) Vendor Specifications Document for the Point of Sale (POS) System July 20, 2015 Version 16 Document Number 3494 Molina Medicaid Solutions and
More informationPRESCRIPTION MONITORING PROGRAM (PMP)
PRESCRIPTION MONITORING PROGRAM (PMP) DATA REPORTING MANUAL Effective Date: April 1, 2012 Contact Information: (505) 222-9830 larry.loring@state.nm.us 1 P a g e Table of Contents Reporting requirements
More informationEDI REPORTS USER GUIDE
EDI REPORTS USER GUIDE BlueCross BlueShield of South Carolina is an independent licensee of the Blue Cross and Blue Shield Association EDI REPORTS USER GUIDE Electronic claim filers can access EDI claim
More informationPharmacy Operating Guidelines & Information
Pharmacy Operating Guidelines & Information RxAMERICA PHARMACY BENEFIT MANAGEMENT Pharmacy Operating Guidelines & Information Table of Contents I. Quick Reference List...3 C. D. E. Important Phone Numbers...
More informationDC DEPARTMENT OF HEALTH Pharmaceutical Procurement and Distribution Pharmaceutical Warehouse. DC Health Care Safety Net ALLIANCE PROGRAM
DC DEPARTMENT OF HEALTH Pharmaceutical Warehouse DC Health Care Safety Net ALLIANCE PROGRAM OPERATIONAL PROTOCOLS Operational protocols for the DC Health Care Alliance program through the DOH Pharmaceutical
More informationMedicare Part D Hospice Care Hospice Information for Medicare Part D Plans
P. O. Box 31397 Tampa, FL 33631 Medicare Part D Hospice Care Hospice Information for Medicare Part D Plans Table of Contents Introduction...2 Background...2 Purpose...2 1) To document that a drug is unrelated
More informationElectronic Signature Guidance
National Council for Prescription Drug Programs White Paper Electronic Signature Guidance Version 1.0 February 2014 This document provides clarification and guidance to the industry for the use of electronic
More informationIn support of a number of our Plan Sponsors, Medco offers the attached year-end communications in preparation for 2012.
LT42423M Medco 100 Parsons Pond Drive Franklin Lakes, NJ 07417 www.medco.com/rph December 2011 Dear Provider: In support of a number of our Plan Sponsors, Medco offers the attached year-end communications
More informationPHARMACY. billing module
PHARMACY billing module Pharmacy Billing Module Coding...2 Basic Rules...2 Before You Begin...2 Reimbursement and Copayment...3 Point of Sale Billing...4 Billing for Split Prescriptions...5 Billing of
More informationCalifornia Division of Workers Compensation Electronic Medical Billing and Payment Companion Guide
California Division of Workers Compensation Electronic Medical Billing and Payment Companion Guide Version 1.0 2012 Preface California Electronic Medical Billing and Payment Companion Guide Purpose of
More informatione Prescribing Overview March 14, 2015
e Prescribing Overview March 14, 2015 e Prescribing Functionality Overview e Prescribing Functionality Overview Medication Network Services Support the change to paperless transactions Prescription Routing
More informationNCPDP Electronic Prescribing Standards
NCPDP Electronic Prescribing Standards September 2014 1 What is NCPDP? An ANSI-accredited standards development organization. Provides a forum and marketplace for a diverse membership focused on health
More informationHIPAA Transactions and Code Set Standards As of January 2012. Frequently Asked Questions
HIPAA Transactions and Code Set Standards As of January 2012 Frequently Asked Questions Version 20 Rev 11222011 Frequently Asked Questions: HIPAA Transactions and Code Set Standards One of the most prominent
More informationREVISION, PROCEDURE CODING SYSTEM (ICD-10-PCS) VERSION 2.Ø
NCPDP IMPLEMENTATION TIMELINES AND RECOMMENDATIONS FOR INTERNATIONAL CLASSIFICATION OF DISEASES, 10TH REVISION, CLINICAL MODIFICATION (ICD-10- CM) AND THE INTERNATIONAL CLASSIFICATION OF DISEASES, 10TH
More informationPharmacy Administrative Manual
Pharmacy Administrative Manual January 2013 TABLE OF CONTENTS Section I. GENERAL INFORMATION Assistance.......................................... 1.1 Fraud, Waste, and Abuse...............................
More informationDEPARTMENT OF HEALTH & MENTAL HYGIENE MEDICAL CARE PROGRAM COMPANION GUIDE FOR 835 HEALTH CARE CLAIM PAYMENT/ADVICE VERSION 005010X221A1
DEPARTMENT OF HEALTH & MENTAL HYGIENE MEDICAL CARE PROGRAM COMPANION GUIDE FOR 835 HEALTH CARE CLAIM PAYMENT/ADVICE VERSION 005010X221A1 February 14, 2011 Version 1.0 Maryland MMIS Page 1 of 5 2/14/2011
More informationData Layouts and Formats
Data Layouts and Formats Pharmacy, Dental, and Provider Files March 13, 2008 INSTITUTE FOR CHILD HEALTH POLICY 1 ENCOUNTERS SUBMISSION GUIDELINES 03/13//2008 Table of Contents 1. INTRODUCTION 3 2. GENERAL
More informationNCHS-CMS Medicare Part D Event File
NCHS-CMS Medicare Part D Event File Variable Name Variable Description Type Length SURVEY NCHS Survey linked to CMS Medicare Data CHAR 16 PUBLICID * NCHS Survey Identifier - Participant Identification
More information835 Health Care Payment/ Remittance Advice Companion Guide
835 Health Care Payment/ Remittance Advice Companion Guide Version 1.6 April 23, 2007 Page 1 Version 1.6 April 23, 2007 TABLE OF CONTENTS VERSION CHANGE LOG 3 INTRODUCTION 4 PURPOSE 4 SPECIAL CONSIDERATIONS
More information837 I Health Care Claim HIPAA 5010A2 Institutional
837 I Health Care Claim HIPAA 5010A2 Institutional Revision Number Date Summary of Changes 1.0 5/20/11 Original 1.1 6/14/11 Added within the timeframes required by applicable law to page 32. Minor edits
More informationWelcome to. Prompt Fulfillment and Delivery 1-844-CUBIST-CARES (1-844-282-4782)
Welcome to When you prescribe SIVEXTRO (tedizolid phosphate) to your patients, our goal is to ensure they have access. That is why AccessSIVEXTRO is committed to helping eligible patients so they can receive
More informationReal-time Pre and Post Claim Edits: Improve Reimbursement, Compliance and Safety
Real-time Pre and Post Claim Edits: Improve Reimbursement, Compliance and Safety An ESI Healthcare Business Solutions White Paper by Thomas Renshaw R.Ph. Introduction Outpatient pharmacies submitting claims
More informationRHODE ISLAND PRESCRIPTION MONITORING PROGRAM DATA COLLECTION MANUAL
RHODE ISLAND PRESCRIPTION MONITORING PROGRAM DATA COLLECTION MANUAL Effective Date: October 13, 2014 Optimum Technology, Inc. Contact Information Phone: 866-683-2476 Fax: 866-282-7076 RIRxReport@otech.com
More informationFAQs on the Required National Provider Identifier (NPI)
FAQs on the Required National Provider Identifier (NPI) Provided by the National Community Pharmacists Association (NCPA) and the National Council for Prescription Drug Programs (NCPDP) At-A-Glance: Important!
More informationSUPPORT PATH PROGRAM INTAKE FORM PHONE: 1-855-769-7284 FAX: 1-855-298-8700
SUPPORT PATH PROGRAM INTAKE FORM PHONE: 1-855-769-7284 FAX: 1-855-298-8700 1 REQUESTED SERVICE(S) (REQUIRED) CHECK ALL BOXES THAT APPLY Benefits Investigation Prior Authorization and Appeals Support Patient
More informationTop 20 D.0 Rejection Reasons
Top 20 D.0 Rejection Reasons Copyright Definitive Homecare Solutions All Rights Reserved. This document is the copyrighted proprietary property of Definitive Homecare Solutions. The unauthorized copying
More informationPOINT OF CLARIFICATION
Follow Up Questions and Answers from the Preparing for the Medicare Part D Requirements for e-prescribing in Long-Term Care Webinar Of June 5 and 12, 2014 NOTE: All answers regarding what is allowed, or
More informationForwardHealth Provider Portal Professional Claims
P- ForwardHealth Provider Portal Professional Claims User Guide i Table of Contents 1 Introduction... 1 2 Access the Claims Page... 2 3 Submit a Professional Claim... 5 3.1 Professional Claim Panel...
More informationREVISION, PROCEDURE CODING SYSTEM (ICD-10-PCS) VERSION 2.2
NCPDP IMPLEMENTATION TIMELINES AND RECOMMENDATIONS FOR INTERNATIONAL CLASSIFICATION OF DISEASES, 10TH REVISION, CLINICAL MODIFICATION (ICD-10- CM) AND THE INTERNATIONAL CLASSIFICATION OF DISEASES, 10TH
More information340B Compliance Self-Assessment: Self-Audit Process Page 1 A Sample Self-Audit Process for Community Health Centers
340B Compliance Self-Assessment: Self-Audit Process Page 1 Purpose: The purpose of this tool is to provide a sample internal audit process to assist participating community health center (CHC) leaders
More informationMAL 565 (Change to Coverage of Prescription Drugs and Certain Supplies) SUBJECT: Changes to Coverage of Prescription Drugs and Certain Supplies
Medical Assistance Letters MAL 565 (Change to Coverage of Prescription Drugs and Certain Supplies) Medical Assistance Letter (MAL) 565 January 26, 2010 TO: All Eligible Pharmacy Providers Directors, County
More informationGUIDANCE FOR THE WORKERS COMPENSATION INDUSTRY
NCPDP Work Group 16 Property & Casualty/Workers Compensation GUIDANCE FOR THE WORKERS COMPENSATION INDUSTRY VERSION 2.1 This document offers guidance to the Workers Compensation industry on the use of
More informationPharmacy Claims Processing Manual
Pharmacy Claims Processing Manual for the Michigan Department of Community Health Medicaid Adult Benefits Waiver (ABW) Children s Special Health Care Services (CSHCS) Maternity Outpatient Medical Services
More information837 Health Care Claim: Professional
837 Health Care Claim: Professional Non-Emergency Transportation HIPAA/V5010X222A1/837: Health Care Claim Professional, Louisiana edicaid Version: 1.1 Revised: 07/21/14 The purpose of this guide is to
More informationMassachusetts Department of Public Health (MDPH) Prescription Monitoring Program (MA PMP) and Drug Control Program (DCP) April 8, 2014
MA PMP Pharmacy Data Entry and Data Submitter s FAQ Utilizing ASAP 4.2 Supplement to the MA PMP Pharmacy Data Entry and Data Submitter s Guide Utilizing ASAP 4.2 Massachusetts Department of Public Health
More information837P Health Care Claim Professional
837P Health Care Claim Professional Revision summary Revision Number Date Summary of Changes 6.0 5/27/04 Verbiage changes throughout the companion guide 7.0 06/29/04 Updated to include the appropriate
More informationLOUISIANA PRESCRIPTION MONITORING PROGRAM
LOUISIANA PRESCRIPTION MONITORING PROGRAM DATA COLLECTION MANUAL - VERSION 1.0 Revision History Date Version Description Author 12/13/2013 1.0 Initial version Lena Roe (Otech) 1/28/2014 1.1 Updates Lena
More informationDepartment of Vermont Health Access Pharmacy Benefit Management Program Provider Manual 2015
Department of Vermont Health Access Agency of Human Services Department of Vermont Health Access Pharmacy Benefit Management Program Provider Manual 2015 Updated January 1, 2015 Table of Contents Introduction
More informationNEW JERSEY PRESCRIPTION MONITORING PROGRAM (NJPMP)
NEW JERSEY PRESCRIPTION MONITORING PROGRAM (NJPMP) DATA COLLECTION MANUAL Effective Date: January 1, 2015 Optimum Technology, Inc. Contact Information Phone: 866-683-2476 NJRxReport@otech.com Fax: 866-282-7076
More informationIBM Gentran:Server for Microsoft Windows. HIPAA and NCPDP Compliance Guide
IBM Gentran:Server for Microsoft Windows HIPAA and NCPDP Compliance Guide Version 5.3 4232-520-USER29-0001 Copyright This edition applies to the 5.3 Version of IBM Sterling Gentran:Server for Microsoft
More informationLOUISIANA PRESCRIPTION MONITORING PROGRAM DATA COLLECTION MANUAL
LOUISIANA PRESCRIPTION MONITORING PROGRAM DATA COLLECTION MANUAL Effective Date: January 1, 2015 Optimum Technology, Inc. Contact Information Phone: 866-683-2476 LABPPMP@otech.com Fax: 866-282-7076 Table
More informationInstructions for Completing the Initial System Assessment for Upcoming HIPAA Changes Due Date: (specify date)
for Completing the Initial System Assessment for Upcoming HIPAA Changes Due Date: (specify date) Some major changes to the HIPAA federally mandated regulations are forthcoming. Therefore, it is essential
More informationNCPDP Pharmacy Reference Guide to the ASC X12/ØØ5Ø1ØX221A1 Health Care Claim Payment/Advice (835)
NCPDP Pharmacy Reference Guide to the ASC X12/ØØ5Ø1ØX221A1 Health Care Claim Payment/Advice (835) VERSION 4.Ø This paper offers guidance to the pharmacy industry in preparing for the implementation of
More informationPennsylvania Department Of Human Services ESC Error Status Code Descriptions 201 BILLING PROVIDER IDENTIFICATION NUMBER IS MISSING FROM CLAIM 202
Pennsylvania Department Of Human Services ESC Error Status Code Descriptions 201 BILLING PROVIDER IDENTIFICATION NUMBER IS MISSING FROM CLAIM 202 BILLING PROVIDER IDENTIFICATION NUMBER IS IN INVALID FORMAT
More informationExCPT Certified Pharmacy Technician (CPhT) Detailed Test Plan* 100 scored items, 20 pretest items Exam time: 2 hours 10 minutes
ExCPT Certified Pharmacy Technician (CPhT) Detailed Test Plan* 100 scored items, 20 pretest items Exam time: 2 hours 10 minutes # scored items 1. Regulations and Pharmacy Duties 35 A. Overview of technician
More informationNew Medicaid POS Claims Processor
No. 31 day, December, 2006 In an effort to give timely notice to the pharmacy community concerning important pharmacy topics, the Department of Health and Mental Hygiene s (DHMH) Maryland Pharmacy Program
More informationArkansas Blue Cross Blue Shield EDI Report User Guide. May 15, 2013
Arkansas Blue Cross Blue Shield EDI Report User Guide May 15, 2013 Table of Contents Table of Contents...1 Overview...2 Levels of Editing...3 Report Analysis...4 1. Analyzing the Interchange Acknowledgment
More informationSubmitted via Federal erulemaking Portal
Response to Administrative Simplification: Adoption of a Standard for a Unique Health Plan Identifier; Addition to the National Provider Identifier Requirements; and a Change to the Compliance Date for
More informationState Prescription Monitoring Program (SPMP) Patch PSO*7*408. Release Notes
State Prescription Monitoring Program (SPMP) Patch PSO*7*408 August 2014 Department of Veterans Affairs Product Development Table of Contents 1. Introduction... 1 1.1 Purpose... 1 1.2 Menu with Options...
More informationIMPLEMENTATION GUIDELINES FOR ANSI ASC X12 EDI CONVENTIONS FILE TRANSFER (996) TRANSACTION SET
IMPLEMENTATION GUIDELINES FOR ANSI ASC X12 EDI CONVENTIONS FILE TRANSFER (996) TRANSACTION SET FCA US INFORMATION & COMMUNICATION TECHNOLOGY MANAGEMENT ANSI ASC X12 VERSION/RELEASE 003020 996 File Transfer
More information