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Wednesday, March 20 • 8:01am - 8:45am
States of Implementation Roundtable 9: Impacts of Recommended Changes to NCPDP Pharmacy Claims Standards on the Medicaid Enterprise

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The continued maturation of real-time claims processing for pharmacy benefits paid by SMAs, development of new and innovative pharmacy benefits across all segments of the healthcare industry, advancements in electronic prescribing, and other influences such as the current Opioid epidemic have generated changes in the need to deliver, respond to, and utilize data. Over the past 10 years, NCPDP standards have been updated to accommodate the evolving business and regulatory needs, but utilization of these changes has been limited by the HIPAA Transaction and Code Sets mandates that only allow the use of versions of the standards published in the final rule of 2009.

This roundtable will provide an opportunity for a guided, interactive dialog between participants to discuss timelines that have been recommended for revising the HIPAA transaction requirements for pharmacy, critical factors to properly implement and utilize the newest Telecommunication, Batch, and Batch Standard Subrogation formats, and changes SMAs may need to consider in their policies, State regulations, and State Plan Amendments.


Tisha McGowan

PMO Manager, Missouri HealthNet
Tisha is a certified project manager with an extensive Medicaid background.  She was involved with the HIPAA standard transaction implementation and the transition to NCPDP D.0.  In addition to 20+ years of Medicaid experience, she is also a certified pharmacy technician with retail... Read More →
avatar for Mark Elliott

Mark Elliott

CSG Government Solutions
Mark Elliott is a Principal in CSG's Healthcare and Human Services practice. He has over 25 years of health IT experience in the public and private sectors, providing state agencies with industry standards, regulation, and process guidance related to pharmacy benefits management... Read More →

Wednesday March 20, 2019 8:01am - 8:45am PDT
Key Ballroom 9 (2nd Floor)