Pharmacy Modifications required for January 1, 2014 – MedImpact Healthcare Systems.

Disclosed previously by MedImpact, there are three major changes that are required and needed to be in place within the NCPDP D.0 submissions.    

Part D Claims are now required to have the following field segments populated:

384-4X                  PATIENT RESIDENCE 147-U7                  PHARMACY SERVICE TYPE

 These fields are presently accepted.  MedImpact indicated it will begin rejecting Part D claims without these fields populated by 1/1/2014.

 Medicare Part D allows for 1 Transaction per Transmission

If you are receiving Reject Code 85 – “Claim not Processed” with the message of: MEDICARE PART D CLAIMS MUST BE SENT AS ONE CLAIM PER TRANSMISSION – please let us know at Universal Software Solutions, so we can help your staff configure the HDMS tables properly and avoid this rejection.    This may apply most to Bin 015574, but the options are designed to work for any payer.

 You may find additional information in Section 7 CLAIM BILLING OR ENCOUNTER INFORMATION of the D.0 NCPDP Implementation Guide for the following:

 “For Medicare Part D processing only one transaction per transmission is permitted because there is a need for the sequencing of the True Out Of Pocket (TrOOP) update before the next claim is processed. The TrOOP should be updated before subsequent claims are.”

Submission Clarification Code

 Code 44 was removed as of April 2013 – “For prescriber ID submitted, associated prescriber DEA recently licensed or re-activated” from the list of valid codes.    You should plan on using one of the other appropriate Submission Clarification Codes as needed, to override the prescriber data if needed.

 These modifications are in place within HDMS and its Pharmacy Companion application in HDMS version 3.8 and later.