Will ESI use the NCPDP 5.1 or the X12 837 format for retail pharmacy supply billings?
We have determined that NCPDP 5.1 is the appropriate format to use when retail pharmacies transmit claims to ESI, including claims for supplies. Generally speaking, the X12 837 format is not the best approach because it may impair clinical care, increase financial risk placed on pharmacies, and generate payment redundancies. Furthermore, the fact that the regulations do not clearly state which standard to use when submitting "pharmacy supply" claims coupled with the fact that the NCPDP 5.1 format has already been successfully used by pharmacies for many years makes NCPDP 5.1 the best format to use.
In addition, while the NCPDP 5.1 format supports real time communications, the X12 837 format only supports batch processing. Implementing the X12 837 format would set our industry back because the pharmacy industry has been using the NCPDP standard for many years.
Kathleen A. Neugebauer, R.Ph.
Product Manager, High Volume Group
TechRx(tm) Inc.
The Backbone of Pharmacy
Commerce
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