decisionhealth Newsletters, Answer Books - 2006 Issue 3 (March)
Program_Memos / 2002 / B-02-052
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Article Overview
This memorandum explains CMS and DMERC implementation requirements for retail pharmacy drug claim processing, including batch processing, remittance advice, system updates, provider outreach, testing timelines, and budget request considerations. It is intended for Medicare contractors, pharmacies, clearinghouses, vendors, and other stakeholders involved in electronic claim exchange and HIPAA transaction compliance.
Why This Topic Matters
The article helps readers understand which pharmacy claim transactions are covered, what operational and outreach steps were expected, and how CMS tied the change to broader HIPAA electronic transaction requirements and contractor budgeting.
Article Sections
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Implementation requirements for NCPDP claim processing
Summarizes the system and transaction-processing expectations for inbound and outbound retail pharmacy claim handling, including batch processing and related remittance advice format considerations.
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Provider Outreach
Describes notification, testing, education, and coordination expectations for pharmacies, clearinghouses, vendors, and other participants affected by the implementation.
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Cost Issues
Covers budgeting, supplemental funding request expectations, and the categories of implementation-related costs to be considered by DMERCs.
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Manualization of this Information and DMERC Contract Modification
Notes planned manual updates, contract changes, effective dates, and implementation milestones associated with the memorandum.
What You Will Learn
- The general scope of the pharmacy claims implementation addressed by the memorandum.
- Which stakeholder groups were expected to prepare for testing, outreach, and system changes.
- How the memorandum connects claim-processing changes with contractor budgeting and administrative updates.
- The timing and sequencing of major implementation milestones discussed in the document.
Who Should Read This
- Medicare contractors
- DMERC staff
- Pharmacies
- Clearinghouses
- Billing services and vendors
- Healthcare compliance and billing professionals
Codes Discussed
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