Don’t forget D.0
While everyone’s scrambling to comply with ANSI X12 5010 standards for HIPAA transactions by Jan. 1—or whenever CMS gets around to enforcing them—there’s another piece of the upgrade that hasn’t been talked about much. That’s the National Council for Prescription Drug Programs’ version D.0 standard for pharmacy transactions.
I got an inadvertent reminder this week when I picked up some prescription refills. One of my meds was out of refills, so my doctor sent a refill electronically (woohoo). Inside the bag of meds was a printout that may not have been intended for me to see, or perhaps I was supposed to mention it to my doctor. The notice contained a “reject message” with the note, “VERSION D.0 REQUIRED AS OF 1/1/2012.
Obviously, the script went through and I got my refill, but I sure hope people don’t start getting prescriptions actually rejected for being in the old NCPDP 5.1 format after the first of the year. Prescribers, get in touch with your vendors. Vendors, remind your e-prescribing clients. It’s not a big change like 5010 and the forthcoming ICD-10, but it’s significant. So get it done.
What you got was a text message (not necessarily a “reject message”) intended for your pharmacist and his vendor to read, probably not for you and certainly not for your doctor. The “Version D.0” reference is to the Telecommunication CLAIM BILLING transaction between the pharmacy and your insurance company’s processor/PBM. HIPAA transaction rules don’t currently dictate the version of e-prescribing (SCRIPT) standard to use.
Just because the CMS OESS isn’t enforcing compliance, don’t expect that many of the larger PBMs and processors won’t start pressing for it on January 1st. And I don’t think you’d hear many conducting claim billing transactions — particularly pharmacies — with agreeing that the upgrade to version D.0 is less significant than for version 5010.