ON JAN. 1, 2012, RETAILERS that operate pharmacies will need to be in compliance with two new standards governing the electronic transmission of prescription claims and other communications to insurance companies.
In one case, pharmacies must upgrade the electronic claims billing standard set by the National Council for Prescription Drug Programs (NCPDP) from version 5.1 to version D.0. This means that pharmacy management systems need to comply with the new standard for processing claims, eligibility inquiries, prior authorization requests and coordination of benefits.
Bob Egeland, vice president of pharmacy for Hy-Vee, West Des Moines, Iowa, said his 231 retail pharmacies will be ready for the new standards by 2012. The chain, he noted, is rolling out standards-compliant EnterpriseRx pharmacy management software from McKesson Pharmacy Systems, San Francisco, to most of the chain by the end of 2011, including about 100 stores that have already installed the software. In 20 to 30 stores that won't receive the new software until the third week of January next year, Hy-Vee is updating their current software this month to meet the new standards.
Similarly, pharmacy systems must adhere to version 5010 of Accredited Standards Committee (ASC) X12, chartered by the American National Standards Institute for electronic data communications.
Both standards were adopted in 2009 by the secretary of the U.S. Department of Health and Human Services for HIPAA-covered transactions.
Retailers have been working toward complying with the new standards “for quite a while,” said Cathy Polley, vice president of health and wellness for the Food Marketing Institute, Arlington, Va. “Software vendors have been receptive and it's working pretty well.”