2002 Press Releases
NCPA X12 Pharmacy Companion Guide Available for Purchase
NCPA X12 Pharmacy Companion Guide Available for Purchase
Alexandria, Virginia - February 13, 2002
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 formation of a national expert panel on the development of the X12N 837 Companion Guide for Pharmacy Professional Claims. The panel convened in January 2001.
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.
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 IGs exist for dental services and institutional services.
Like the IGs, the Pharmacy Companion Guide is an EDI subset that addresses industry-specific EDI implementation issues, and includes explanatory front-matter, figures, examples, and cross-references. The Pharmacy Companion Guide consists of electronic transaction segments that are "required" for submission with each professional claim and "situational" segments for additional information required by an intermediary or payor.
NCPA's X12 Advisory Panel included representatives from the American Society of Automation in Pharmacy (ASAP) who are experts in computer software for pharmacist care and DME billing: Rita Ayers, vice president, DME Services, Health Link Systems; Charles Best, manager of Care Rx, PDX/NHIN; Bill Etreby, Pharm.D., president, Etreby Computer Corp.; Bill Lockwood, executive director, ASAP; Jerry Ransom, Ph.D., president, OmniSYS; Bruce Rodman, manager of client services, Abbott Home Infusion Services, representing the National Home Infusion Association (NHIA); Michael T. Rupp, Ph.D., professor, Midwestern University-Glendale, Arizona; Jeanne Ann Stasny, R.Ph., president, jASCorp.; and Teresa Strickland, software development analyst, Healthcare Computer Corporation. Kathryn Kuhn, R.Ph., vice president, pharmacy programs, NCPA, served as staff liaison. Stuart Beaton, vice president, Washington Publishing, assisted with the development of the Pharmacy Companion Guide.
The Pharmacy Companion Guide is available for $50 for the downloadable PDF file via Washington Publishing's website, www.wpc-edi.com/hipaa (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.
Since 1993, NCPA has been focused on X12 coding and billing transactions by educating pharmacists on how to use CPT and HCPCS codes in community pharmacy practice for reporting and billing professional services, procedures, and supplies to health plans, specifically major medical insurance carriers. Several publications are available from NCPA that describe these billing procedures — The NCPA User's Manual: A Comprehensive Guide to Pharmacist Care Documentation and Compensation and Pricing Pharmacist Care Services.
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.
CONTACT:
Deleisa Johnson
Vice President, Communications
National Community Pharmacists Association
205 Daingerfield Rd
Alexandria, VA 22314
(703) 683-8200
Deleisa.Johnson@ncpanet.org