Administrative Simplification: Modifications of Health Insurance Portability and Accountability Act of 1996 (HIPAA) National Council for Prescription Drug Programs (NCPDP) Retail Pharmacy Standards; and Modification of the Medicaid Pharmacy Subrogation Standard
medicaid · Centers for Medicare and Medicaid Services · Rule · Published 2024-12-13 · Effective 2025-02-11 · 89 FR 100763
Document
Document number
2024-29138
Federal Register citation
89 FR 100763
CFR reference
45 CFR 162
Type
Rule
Action
Final rule.
Category
medicaid
Sub-agency
Centers for Medicare and Medicaid Services
Publication date
2024-12-13
Effective date
2025-02-11
HHS docket
CMS-0056-F
Abstract
This final rule adopts updated versions of the retail pharmacy standards for electronic transactions adopted under the Administrative Simplification subtitle of the Health Insurance Portability and Accountability Act of 1996 (HIPAA). These updated versions are modifications to the currently adopted standards for the following retail pharmacy transactions: health care claims or equivalent encounter information; eligibility for a health plan; referral certification and authorization; and coordination of benefits. This final rule also adopts a modification to the standard for the Medicaid pharmacy subrogation transaction.