Program_Memos / 2003 / B-03-024

Why This Topic Matters

It summarizes operational and compliance changes that affect how retail pharmacy claims are transmitted, tested, and coordinated with Medicare systems, making it useful for organizations preparing or validating NCPDP-based claim workflows.

Article Sections

1. Overview and implementation update

   Introduces the memorandum, its purpose, and the scope of the implementation update for retail pharmacy transactions.

2. National Drug Codes and narrative information

   Discusses retail pharmacy claim submission requirements related to drug identifiers and the use of a narrative field for certain supporting information.

3. Compound drugs

   Summarizes how compound pharmacy claims are handled within the NCPDP framework and identifies related transaction fields used in the process.

4. Parenteral nutrition, enteral nutrition, ESRD, and home infusion claims

   Covers billing format guidance for several categories of Medicare claims submitted by pharmacies and related providers.

5. NDC/HCPCS crosswalk

   Describes crosswalk coordination between drug identifiers and HCPCS-based claim handling, along with timing and update notes.

6. Mapping metric decimal quantities to the X12N 835 and 277

   Addresses data transfer issues between NCPDP and X12N response transactions and notes an implementation-related format limitation.

7. Generating a batch response

   Explains batch and transmission handling for NCPDP responses, including how multiple claim transactions are processed.

8. Medicare Secondary Payer (MSP)

   Provides general guidance for inbound NCPDP claim data used in secondary payer processing and related transaction segments.

9. Medigap

   Outlines the data elements referenced for Medigap claim processing within the NCPDP environment.

10. Partial fills

    Notes how partial fill information is treated in the DMERC context and the limits of current functionality.

11. Medicare Part B claims

    Distinguishes certain Part B drug and vaccine claims from the NCPDP retail pharmacy format and indicates other submission methods.

12. Coordination of Benefits (COB)

    Describes how paper claim coordination of benefits is handled through X12N transmission processes.

13. Testing

    Lists the phased testing timeline for internal, beta, and provider-facing validation activities.

14. Provider education or notification

    Summarizes provider and trading partner notification expectations, companion document availability, and general implementation readiness guidance.

15. Cost Issues

    References cost-related implementation instructions and submission timing for CMS reporting.