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Elizabeth M. Whitehorn, Director

Provider Notice issued 08/27/04

New Edits for NCPDP Version 5.1 and Version 1.1

To:​

Participating Hospitals and Pharmacies ​

Date:​ August 27, 2004​
Re:​ New Edits for NCPDP Version 5.1 and Version 1.1 ​

Effective October 18, 2004, the department will activate a new set of edits for both Version 5.1 and Version 1.1 of the NCPDP transaction formats.

The new edits will check the content and format of every field submitted in a transmission, in either format. Each field submitted must conform to the Telecommunications Standard Implementation Guide and the definitions found in the Version 5.1 Data Dictionary.

Any field found to be in error will cause the individual transmission to reject. The rejected transmission will be assigned an Authorization Number, which will appear in field 503-F3. The Authorization Number will be used by the department to assist the pharmacy in identifying and correcting the errors that caused the translator rejection. The department will return a NCPDP 5.1 Reject Code for the field in error. Pharmacies may need to contact their software vendor if they receive one of these reject codes.

It is the responsibility of each provider to ensure that all material related to changes in the department’s billing procedures, handbooks, etc., are shared with their software vendor, corporate help desk or information systems area.

If you have any questions concerning this notice, you may contact a pharmacy billing representative by calling 217-782-5565 and selecting Option 7 for the Pharmacy Program.

Anne Marie Murphy, Ph.D.

Administrator

Division of Medical Programs