2002 Press Releases
Joint NCPA / APhA / ACPE New Release
Joint NCPA / APhA / ACPE New Release
Alexandria, Virginia - April 30, 2002
As a first step, NCPA, APhA, and ASCP will be working together on the creation of an X12 Pharmacy Advisory Panel. The panel will be made up of industry stakeholders who will provide oversight for the X12N 837 Companion Guide for Pharmacy Professional Claims, suggesting modifications and updates for the guide and defining a process for doing so.
"NCPA is proud to have taken the lead on the X12 issue and fostered the creation of the Pharmacy Companion Guide," said Bruce Roberts, R.Ph., executive vice president and CEO of NCPA. "The HIPAA regulations provide a new opportunity for pharmacists to electronically bill for their professional services using X12 just as other health care providers, such as physicians and dentists do. However, this is really nothing new. For years, pharmacists have been billing for durable medical equipment, prosthetics, orthotics, and supplies (DMEPOS) through X12’s paper format, the HCFA-1500 form. Using X12 as the electronic standard for billing pharmacist professional services just takes that practice to the next level, and the X12 Advisory Panel will provide pharmacists with a new level of control in their profession."
"We are excited to be joining with NCPA to promote the adoption of X12 as the preferred standard for electronic billing for pharmacist professional services and in the formation of the X12 Pharmacy Advisory Panel," said John Gans, Pharm.D., executive vice president and CEO of APhA. "APhA has been a leader in advancing the issues of payment for pharmacist’s services and improving the pharmacist’s work environment, and using the X12 standard to bill health plans helps advance both agendas. X12 is the accepted standard of communication between medical payors and health care providers nationwide and will provide another billing mechanism for pharmacy. The advisory panel will serve to provide oversight from the profession for the X12 standards as they relate to pharmacy. We look forward to working with NCPA and other pharmacy organizations to advance the adoption of this standard in community pharmacy and all other pharmacist practice settings."
X12, an organization accredited by the American National Standards Institute (ANSI), facilitates the development of uniform standards to streamline electronic data interchange (EDI) within a variety of industries. X12N is the insurance subcommittee of X12. X12N 837 refers to health care insurance claims for professional services, including professional physician/pharmacist services, disease state management, and durable medical equipment. Other X12N 837 Implementation Guides exist for dental services and institutional services.
The Health Insurance Portability and Accountability Act (HIPAA) directs the Secretary of the Department of Health and Human Services (HHS) to adopt standards for transactions and data elements for such transactions, to enable health information to be exchanged electronically.
In preparation for HIPAA implementation in community pharmacies, NCPA led the movement for X12 with the formation of a national expert panel, which developed the X12N 837 Companion Guide for Pharmacy Professional Claims.
The Pharmacy Companion Guide provides instruction on the data transaction segments of the ASC X12N 837 Insurance Subcommittee Implementation Guide (IG) Health Care Claim: Professional that are germane to community pharmacy along with sample cases from disease state management claims and durable medical equipment (DME) claims. The transactions in this companion document are compliant with both X12 syntax and the HIPAA Health Care Claim: Professional Implementation Guide 004010X098.
The Pharmacy Companion Guide is available for $50 for the downloadable PDF file via Washington Publishing’s website, www.wpc-edi.com (to access the file, click on the HIPAA link, then click on the announcement at the top of the page), $75 for the PDF file on a diskette, or $92 for a printed bound version.
The National Community Pharmacists Association (NCPA) represents the pharmacist owners, managers, and employees of nearly 25,000 independent community pharmacies across the country. The nation’s independent pharmacies, independent pharmacy franchises, and independent chains dispense nearly half of the nation's three billion retail prescription medicines and account for nearly $50 billion in prescription drug sales each year.
The American Pharmaceutical Association (APhA) is the first established and largest professional association of pharmacists in the United States. APhA’s 50,000 members include practicing pharmacists, pharmaceutical scientists, pharmacy students, pharmacy technicians, and others interested in advancing the profession. The Association is a leader in providing professional information and education for pharmacists and an advocate for improved health through the provision of pharmaceutical care.
The American Society of Consultant Pharmacists (ASCP) is the international professional association that provides leadership, education, advocacy, and resources to advance the practice of senior care pharmacy. Consultant pharmacists specializing in senior care pharmacy practice are essential participants in the health care system, recognized and valued for the practice of pharmaceutical care for the senior population and people with chronic illness. In their role as medication therapy experts, consultant pharmacists take responsibility for their patients' medication-related needs; ensure that their patients' medications are the most appropriate, the most effective, the safest possible, and are used correctly; and identify, resolve, and prevent medication-related problems that may interfere with the goals of therapy. ASCP's 7,000 members manage and improve drug therapy and improve the quality of life of geriatric patients and other individuals residing in a variety of environments, including nursing facilities, subacute care and assisted living facilities, psychiatric hospitals, hospice programs, and in home and community-based care.
CONTACTS:
NCPA Contact: Deleisa Johnson
703-683-8200
www.ncpanet.org
APhA Contact: Tina L. Pugliese, APR
202-429-7558
www.aphanet.org
ASCP Contact: Bob Appel
703/739-1316 ext. 115
www.ascp.com