Who is NCPDP?
- An ANSI-accredited standards development organization (SDO).
- Develops and maintains standards for the pharmacy services sector of the health care industry.
- NCPDP maintains the HIPAA-named national standard for the transmission of pharmacy claims (Telecom Version 5.1)
NCPDP Mission Statement
- To create and promote data interchange standards for the pharmacy services sector of the health care industry; and
- To provide information and resources that educate the industry and support the diverse needs of our members.
Standardization of Paper Claims
- NCPDP was formed in 1977 to standardize the drug insurance claim.
- NCPDP’s developed the paper Universal Claim Form (UCF) which was adopted in 1978.
- Over three billion claim forms have been distributed to date.
The Evolution of Pharmacy Claims Processing – 80s
- Eligibility checked on-line prior to Rx.
- Claims submitted on tape or diskettes in NCPDP Batch Claims Standard Version 1.0 in 1984.
- Claims processed after prescription was filled. Claims pended and processor “worked” or denied.
