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Pharmacy claims must be submitted in the NCPDP D.0 format or they will reject
The National Council for Prescription Drug Programs (NCPDP) maintains requirements regarding the standard way pharmacy claims must be transmitted. Telecommunications Standard Version D.0 is an updated version of the Health Insurance Portability and Accountability Act (HIPAA) standard for pharmacy claims transactions. It is an online, real-time request from the pharmacy to the health plan AND a response from the health plan to the pharmacy.
Covered entities, including pharmacies, are required to conform to HIPAA 5010 standards.
If you have questions about specific fields included within the Aetna D.0 Payer Sheets listed below, related to your software screens/capabilities, please consult with your chain headquarters (if applicable) or software vendor for assistance.
Aetna 2014 Payer Sheets (detailed technical specifications):
Aetna 2013 Payer Sheets (detailed technical specifications):