NCPDP Telecommunication D.0

NCPDP Telecommunication Standard vD.0, the HIPAA pharmacy claim standard.

Definition

vD.0 governs the real-time transaction between pharmacy and payer (B1 claim billing, B2 reversal, E1 eligibility request). It uses named-field segments (Claim, Insurance, Pricing) rather than X12 syntax; claims for supplies and services stay in X12 837 and are sent in a separate transmission.

Origin

Published and maintained by the National Council for Prescription Drug Programs (NCPDP); named the HIPAA standard for retail pharmacy claims, with compliance required by January 1, 2012.

Example in context

Field 436-E1 (Product/Service ID Qualifier) = 03 then 407-D7 (Product/Service ID) = the drug's NDC, in a B1 (Billing) transaction sent from the pharmacy to the PBM.

Related terms

• HIPAA X12N — the 837 medical claims, the complementary format.
• GTIN — the GS1 product key, distinct from the pharmaceutical NDC.