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Elizabeth M. Whitehorn, Director

Provider Notice issued 10/21/03

National Council on Prescription Drug Programs (NCPDP) Billing Changes

 

​To: ​Participating Pharmacists
​Date: ​October 21, 2003
​Re: ​National Council on Prescription Drug Programs (NCPDP) Billing Changes

 

The purpose of this notice is to clarify the department's policy on decimal billing of quantities under the Pharmacy Program.

 

 

The department does not allow for decimal billing in the NCPDP Version 3A format. The department's policy for billing on the NCPDP Version 3A is that providers round up the quantity billed. The department is changing this policy when billing the department with NCPDP Version 5.1. The exact quantity dispensed must be reported using NCPDP 5.1.

The department continues to accept NCPDP Version 3A only as a temporary HIPAA contingency plan for pharmacies not yet in compliance with the new NCPDP Version 5.1 requirement. Although the department is still accepting the NCPDP Version 3A, providers are encouraged to begin using the new version 5.1 as soon as possible. The department will announce a date in the near future for when NCPDP Version 3A will no longer be accepted.

Pharmacies should contact their software vendors and advise them that all software should capture, retain and display the Authorization Number returned by the department. Pharmacies need to be able to provide this number to the department when calling about problem billings.

If you have any questions concerning this notice, you may contact the Pharmacy Unit at 217-782-5565.

 

Anne Marie Murphy, Ph.D.

Administrator

Division of Medical Programs