The NCPDP Telecommunications Standard Version D.Ø is an updated version of the HIPAA standard for pharmacy claims transactions.
The Vendor Drug Program will implement NCPDP D.Ø and 5010 ANSI X12 835 electronic remittance advice changes across three phases:
- Phase I implemented Thursday, December 1, 2011. Vendor Drug allowed pharmacy providers to submit claims in either version 5.1 or D.Ø.
Phase II implemented Wednesday, February 1, 2012. VDP no longer accepts claims in version 5.1 on or after this date.
- Please refer to the payer sheets for allowed values for “Group ID” (Field 3Ø1-C1).
- Please refer to the Vendor Drug Pharmacy Provider Procedure Manual, specifically Attachment A: Standard Format Reject Codes for a list of the NCPDP error codes that will be returned by VDP.
- Claims will reject if the last name submitted in the “Patient Last Name” field (311-CB) does not match the last name on file with VDP. Please check the client’s Your Texas Benefits Medicaid Card or program-specific card, to confirm the correct last name. If an incorrect name is submitted, the claim will reject with error code “62” (Patient/Card Holder ID Name Mismatch). If the name on file with VDP is incorrect then please refer the client to his or her caseworker to have the system of record updated.
- Phase III is scheduled to implement on Sunday, July 1, 2012. Benefit Stage and Medigap fields will be accepted for KHC claims.
Please refer to the D.Ø payer sheets for full requirements across the three phases.