HITSP Medication Formulary and Benefits Information Transaction Package

July 8, 2009

Version 1.3

HITSP Medication Formulary and Benefits Information Transaction Package

HITSP/TP46

Healthcare Information Technology Standards Panel (HITSP) logo

Submitted to:

Healthcare Information Technology Standards Panel

Submitted by:

Administrative and Finance Domain Technical Committee

Document Change History

Version Number	Description of Change	Name of Author	Date Published
0.0.1	Review Copy	Care Delivery Technical Committee	December 7, 2007
0.0.2	Review Copy	Care Delivery Technical Committee	March 19, 2008
1.0	Released for Implementation	Care Delivery Technical Committee	March 27, 2008
	Template Updated to V2.4	Project Team	July 31, 2008
1.0.1	Review Copy	Administrative and Finance Domain Technical Committee	August 20, 2008
1.1	Released for Implementation	Administrative and Finance Domain Technical Committee	August 27, 2008
1.1.1	Review Copy	Administrative and Finance Domain Technical Committee	December 10, 2008
1.2	Released for Implementation	Administrative and Finance Domain Technical Committee	December 18, 2008
	Template V2.5	Project Team	June 30, 2009
1.2.1	Review Copy	Administrative and Finance Domain Technical Committee	June 30, 2009
1.3	Released for Implementation	Administrative and Finance Domain Technical Committee	July 8, 2009

Table of Contents

1.0 Introduction. 5

1.1 Overview. 5

1.2 Copyright Permissions. 6

1.3 Reference Documents. 6

1.4 Conformance. 6

1.4.1 Conformance Criteria. 6

1.4.2 Conformance Scoping, Subsetting and Options. 7

2.0 Transaction Definition. 8

2.1 Context Overview. 8

2.1.1 Transaction Package Constraints. 8

2.1.2 Interfaces. 10

2.1.3 Interface Interactions. 10

2.1.4 Pre-conditions. 11

2.1.4.1 Process Triggers. 11

2.1.5 Post-conditions. 11

2.1.5.1 Required Output 11

2.1.6 Data Flows. 11

2.2 List of Constructs. 23

2.2.1 Construct Dependencies. 23

2.2.2 Additional Constraints on Required Constructs. 23

2.3 Standards. 24

2.3.1 Regulatory Guidance. 24

2.3.2 Selected Standards. 24

2.3.3 Informative Reference Standards. 25

3.0 Appendix. 26

4.0 Document Updates. 27

4.1 December 7, 2007. 27

4.2 March 19, 2008. 27

4.3 March 27, 2008. 27

4.4 August 20, 2008. 27

4.5 August 27, 2008. 27

4.6 December 10, 2008. 27

4.7 December 18, 2008. 27

4.8 June 30, 2009. 28

4.9 July 8, 2009. 28

Figures and Tables

Figure 2-1 Medication Formulary and Benefits Information Detailed Design. 10

Table 1-1 Reference Documents. 6

Table 2-1 Transaction Package Constraints. 9

Table 2-2 Interfaces. 10

Table 2-3 Pre-conditions. 11

Table 2-4 Process Triggers. 11

Table 2-5 Post-conditions. 11

Table 2-6 Required Output 11

Table 2-7 X12N 270 Data Mapping. 12

Table 2-8 X12N 271 Data Mapping. 14

Table 2-9 NCPDP Formulary and Benefit Data Load Data Mapping. 23

Table 2-10 List of Constructs. 23

Table 2-11 Construct Dependencies. 23

Table 2-12 Additional Constraints on Required Constructs. 23

Table 2-13 Regulatory Guidance. 24

Table 2-14 Selected Standards. 24

Table 2-15 Informative Reference Standards. 25