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NCPDP Processing

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For NCPDP processing, pharmacy orders originating in Avatar Order Entry must include required information that is transmitted to RxConnect to fill and dispense prescriptions and submit claims to myAvatar PM for NCPDP Medicare Part D and other payers.

The National Council for Prescription Drug Programs (NCPDP) promotes and maintains data interchange standards for pharmacies. These standards include a single standard file submission to be used for pharmacy claims, the NCPDP File Format D.0. This file format can be used to bill pharmacy claims to Medicare Part D prescription drug plans or to other guarantors accepting pharmacy claims.

Here is a brief summary of the NCPDP processing that takes place in myAvatar Order Entry, RxConnect, and myAvatar PM:

  1. Avatar Order Entry sends the pharmacy order to RxConnect to be filled. These orders include the Expected Days Supply, Number of Refills, and DAW that are needed for NCPDP billing.
  2. RxConnect fills and dispenses the order and sends the Fill Days Supply and Fill Quantity to Dispense back to myAvatar Order Entry.
  3. RxConnect submits pharmacy charges to myAvatar PM that include the Fill Days Supply and DAW reason code that are needed for NCPDP billing.
  4. Avatar PM creates a data file that contains the necessary NCPDP information and sends the data file to DayTech where it is converted to the NCPDP billing format and sent to Medicare Part D and NCPDP payors for processing.

The following graphic illustrates how order information in myAvatar Order Entry and RxConnect is used in NCPDP billing.

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