Common use of SPAP Implementation Questionnaire Clause in Contracts

SPAP Implementation Questionnaire. ‌ The SPAP Implementation Questionnaire asks a series of questions of the data sharing partner that assists the BCRC and the partner in setting up the data sharing exchange process. These questions are intended to help you think through some of the issues which need to be addressed before you begin the data exchange and to assure that both the CMS and the SPAP partner are in agreement as to the operational process involved. SPAP partners must fill out, sign and return a copy of the Questionnaire to the CMS with their signed SPAP Data Sharing Agreement. The Questionnaire is also identified as Attachment C in the materials that new SPAP data sharing partners will acquire at the start of the implementation process. Chapter 4: Working with the Data ‌ 4.1 Updates to the SPAP Process‌ Some partners have seen an “ID” value in the Rx Current Disposition Code field (Field 19) for some records in their Response files. The “ID” Disposition Code is being caused by an identification error (an “ID” error) at the MBD, one of the systems feeding data to the BCRC. The records on Input Files from our partners are matched against MBD records. The ID Disposition Code problem arises in some cases because the BCRC tries to apply an incoming record to the MBD, but the MBD does not find any existing record for that particular beneficiary, even though the MBD has already told the BCRC that the record exists. Fortunately, while this is only happening in a very limited number of cases an SPAP might still get some records with the “ID” code, seeming to show that the MBD matching process does not identify the incoming record. However, response records transmitted to the SPAP do include whatever Medicare information the BCRC had already received from MBD and stored for that beneficiary in the BCRC’s own database. While the beneficiary’s data cannot yet be validated absent a confirmation of acceptance from MBD, CMS staff continues to work to resolve this data reporting problem. The MBD feed to the BCRC includes Co-Pay Level ID data for both the LIS and Deemed categories. Field 55 shows LIS Co-Pay Level ID information. Field 56 shows Deemed Co-Pay Level ID information. Partners should note that it is possible for an individual to have both LIS and Deemed Co-Pay Level ID information. For such individuals, the Deemed Co-Pay Level ID information in Field 56 takes priority over the LIS Co-Pay Level ID information in Field 55. Please review Fields 55 and 56 on the SPAP Response File layout, located on Pages 13 and 14. 4.2 Obtaining a TrOOP Facilitation RxBIN or RxPCN‌ TrOOP is the acronym for “true out-of-pocket” – spending by or on behalf of a Medicare beneficiary that counts toward the beneficiary’s Part D cost sharing. SPAP partners that provide their drug benefit using electronic data interchange networks (electronic at point-of-sale) are required to obtain unique electronic routing codes, referred to as their TrOOP facilitation Rx Bank Identification Number (RxBIN). RxBIN and Rx Processor Control Number (RxPCN) (also known as the Part D RxBIN and RxPCN). Within the data management network these unique codes will identify the SPAP partner’s drug benefits that are supplemental to Part D. Using a TrOOP RxBIN and RxPCN will also support the pharmacy point-of-sale coordination system for TrOOP facilitation. The SPAP’s use of a unique TrOOP network routing code will allow the TrOOP Facilitation Contractor to capture the paid claims data of payers supplemental to Part D (including SPAPs) and send a copy of this data to the Part D Plan in which the Medicare beneficiary is enrolled. The Part D Plan will use the supplemental paid claims information it receives from the TrOOP Facilitation Contractor to update the calculation of the beneficiary’s TrOOP. To route these claims through the TrOOP Facilitation Contractor, partners may use a new, separate and unique RxBIN by itself, or a unique TrOOP RxPCN in addition to their existing non-TrOOP network RxBIN. The organization that issues the RxBIN is the American National Standards Institute, or ANSI. (Note that a BIN is sometimes referenced as an IIN; an IIN is a BIN.) ANSI can be contacted through its web address: xxx.xxxx.xxx/. The National Council for Prescription Drug Programs (NCPDP) issues the RxPCN. For TrOOP Facilitation routing, you can use a new RxPCN or obtain and use an additional RxPCN in lieu of an additional RxBIN. The NCPDP can be contacted through its web address: xxx.xxxxx.xxx. 4.3 Testing the Data Exchange Process‌ After all file transmission testing has been completed to the satisfaction of both the SPAP Data Sharing partner and CMS, the partner may begin submitting its regular production files to the BCRC, in accordance with the provisions of Sections C and D of the SPAP Data Sharing Agreement. In order to test the process for creating an Update File, a test “Update” shall be prepared by the partner and include data regarding individuals identified in the Test File. The partner shall submit the test Update data within ninety (90) days after receipt of the test Response File. The Test File Update shall include any corrections made in the previous Test Response File sent to the partner by the BCRC. For full file replacement, any corrections made to a file will fully replace what was previously submitted by the Partner. Upon completion of its review of the test update, the BCRC shall provide the partner a Response for every record found on the Test Update File. The BCRC shall provide a Test Update Response File to the partner, within a week, but no longer than forty-five (45) days after receipt of the partner’s Test Update File. Once the BCRC and the SPAP partner have completed all file transmission testing to the satisfaction of both parties, the partner may begin submitting its regular production files to the BCRC.

SPAP Implementation Questionnaire. ‌ The SPAP Implementation Questionnaire asks a series of questions of the data sharing partner that assists the BCRC and the partner in setting up the data sharing exchange process. These questions are intended to help you think through some of the issues which need to be addressed before you begin the data exchange and to assure that both the CMS and the SPAP partner are in agreement as to the operational process involved. SPAP partners must fill out, sign and return a copy of the Questionnaire to the CMS with their signed SPAP Data Sharing Agreement. The Questionnaire is also identified as Attachment C in the materials that new SPAP data sharing partners will acquire at the start of the implementation process. Chapter 4: Working with the Data ‌Data‌ 4.1 Updates to the SPAP Process‌ Some partners have seen an “ID” value in the Rx Current Disposition Code field (Field 19) for some records in their Response files. The “ID” Disposition Code is being caused by an identification error (an “ID” error) at the MBD, one of the systems feeding data to the BCRC. The records on Input Files from our partners are matched against MBD records. The ID Disposition Code problem arises in some cases because the BCRC tries to apply an incoming record to the MBD, but the MBD does not find any existing record for that particular beneficiary, even though the MBD has already told the BCRC that the record exists. Fortunately, while this is only happening in a very limited number of cases an SPAP might still get some records with the “ID” code, seeming to show that the MBD matching process does not identify the incoming record. However, response records transmitted to the SPAP do include whatever Medicare information the BCRC had already received from MBD and stored for that beneficiary in the BCRC’s own database. While the beneficiary’s data cannot yet be validated absent a confirmation of acceptance from MBD, CMS staff continues to work to resolve this data reporting problem. The MBD feed to the BCRC includes Co-Pay Level ID data for both the LIS and Deemed categories. Field 55 shows LIS Co-Pay Level ID information. Field 56 shows Deemed Co-Pay Level ID information. Partners should note that it is possible for an individual to have both LIS and Deemed Co-Pay Level ID information. For such individuals, the Deemed Co-Pay Level ID information in Field 56 takes priority over the LIS Co-Pay Level ID information in Field 55. Please review Fields 55 and 56 on the SPAP Response File layout, located on Pages 13 and 14. 4.2 Obtaining a TrOOP Facilitation RxBIN or RxPCN‌ TrOOP is the acronym for “true out-of-pocket” – spending by or on behalf of a Medicare beneficiary that counts toward the beneficiary’s Part D cost sharing. SPAP partners that provide their drug benefit using electronic data interchange networks (electronic at point-of-sale) are required to obtain unique electronic routing codes, referred to as their TrOOP facilitation Rx Bank Identification Number (RxBIN). RxBIN and Rx Processor Control Number (RxPCN) (also known as the Part D RxBIN and RxPCN). Within the data management network these unique codes will identify the SPAP partner’s drug benefits that are supplemental to Part D. Using a TrOOP RxBIN and RxPCN will also support the pharmacy point-of-sale coordination system for TrOOP facilitation. The SPAP’s use of a unique TrOOP network routing code will allow the TrOOP Facilitation Contractor to capture the paid claims data of payers supplemental to Part D (including SPAPs) and send a copy of this data to the Part D Plan in which the Medicare beneficiary is enrolled. The Part D Plan will use the supplemental paid claims information it receives from the TrOOP Facilitation Contractor to update the calculation of the beneficiary’s TrOOP. To route these claims through the TrOOP Facilitation Contractor, partners may use a new, separate and unique RxBIN by itself, or a unique TrOOP RxPCN in addition to their existing non-TrOOP network RxBIN. The organization that issues the RxBIN is the American National Standards Institute, or ANSI. (Note that a BIN is sometimes referenced as an IIN; an IIN is a BIN.) ANSI can be contacted through its web address: xxx.xxxx.xxx/. The National Council for Prescription Drug Programs (NCPDP) issues the RxPCN. For TrOOP Facilitation routing, you can use a new RxPCN or obtain and use an additional RxPCN in lieu of an additional RxBIN. The NCPDP can be contacted through its web address: xxx.xxxxx.xxx. 4.3 Testing the Data Exchange Process‌ After all file transmission testing has been completed to the satisfaction of both the SPAP Data Sharing partner and CMS, the partner may begin submitting its regular production files to the BCRC, in accordance with the provisions of Sections C and D of the SPAP Data Sharing Agreement. In order to test the process for creating an Update File, a test “Update” shall be prepared by the partner and include data regarding individuals identified in the Test File. The partner shall submit the test Update data within ninety (90) days after receipt of the test Response File. The Test File Update shall include any corrections made in the previous Test Response File sent to the partner by the BCRC. For full file replacement, any corrections made to a file will fully replace what was previously submitted by the Partner. Upon completion of its review of the test update, the BCRC shall provide the partner a Response for every record found on the Test Update File. The BCRC shall provide a Test Update Response File to the partner, within a week, but no longer than forty-five (45) days after receipt of the partner’s Test Update File. Once the BCRC and the SPAP partner have completed all file transmission testing to the satisfaction of both parties, the partner may begin submitting its regular production files to the BCRC.

SPAP Implementation Questionnaire. ‌ The SPAP Implementation Questionnaire asks a series of questions of the data sharing partner that assists the BCRC and the partner in setting up the data sharing exchange process. These questions are intended to help you think through some of the issues which need to be addressed before you begin the data exchange and to assure that both the CMS and the SPAP partner are in agreement as to the operational process involved. SPAP partners must fill out, sign and return a copy of the Questionnaire to the CMS with their signed SPAP Data Sharing Agreement. The Questionnaire is also identified as Attachment C in the materials that new SPAP data sharing partners will acquire at the start of the implementation process. Chapter 4: Working with the Data ‌Data‌ 4.1 Updates to the SPAP Process‌ Some partners have seen an “ID” value in the Rx Current Disposition Code field (Field 19) for some records in their Response files. The “ID” Disposition Code is being caused by an identification error (an “ID” error) at the MBD, one of the systems feeding data to the BCRC. The records on Input Files from our partners are matched against MBD records. The ID Disposition Code problem arises in some cases because the BCRC tries to apply an incoming record to the MBD, but the MBD does not find any existing record for that particular beneficiary, even though the MBD has already told the BCRC that the record exists. Fortunately, while this is only happening in a very limited number of cases an SPAP might still get some records with the “ID” code, seeming to show that the MBD matching process does not identify the incoming record. However, response records transmitted to the SPAP do include whatever Medicare information the BCRC had already received from MBD and stored for that beneficiary in the BCRC’s own database. While the beneficiary’s data cannot yet be validated absent a confirmation of acceptance from MBD, CMS staff continues to work to resolve this data reporting problem. The MBD feed to the BCRC includes Co-Pay Level ID data for both the LIS and Deemed categories. Field 55 shows LIS Co-Pay Level ID information. Field 56 shows Deemed Co-Pay Level ID information. Partners should note that it is possible for an individual to have both LIS and Deemed Co-Pay Level ID information. For such individuals, the Deemed Co-Pay Level ID information in Field 56 takes priority over the LIS Co-Pay Level ID information in Field 55. Please review Fields 55 and 56 on the SPAP Response File layout, located on Pages 13 and 14. 4.2 Obtaining a TrOOP Facilitation RxBIN or RxPCN‌ TrOOP is the acronym for “true out-of-pocket” – spending by or on behalf of a Medicare beneficiary that counts toward the beneficiary’s Part D cost sharing. SPAP partners that provide their drug benefit using electronic data interchange networks (electronic at point-of-sale) are required to obtain unique electronic routing codes, referred to as their TrOOP facilitation Rx Bank Identification Number (RxBIN). RxBIN and Rx Processor Control Number (RxPCN) (also known as the Part D RxBIN and RxPCN). Within the data management network these unique codes will identify the SPAP partner’s drug benefits that are supplemental to Part D. Using a TrOOP RxBIN and RxPCN will also support the pharmacy point-of-sale coordination system for TrOOP facilitation. The SPAP’s use of a unique TrOOP network routing code will allow the TrOOP Facilitation Contractor to capture the paid claims data of payers supplemental to Part D (including SPAPs) and send a copy of this data to the Part D Plan in which the Medicare beneficiary is enrolled. The Part D Plan will use the supplemental paid claims information it receives from the TrOOP Facilitation Contractor to update the calculation of the beneficiary’s TrOOP. To route these claims through the TrOOP Facilitation Contractor, partners may use a new, separate and unique RxBIN by itself, or a unique TrOOP RxPCN in addition to their existing non-TrOOP network RxBIN. The organization that issues the RxBIN is the American National Standards Institute, or ANSI. (Note that a BIN is sometimes referenced as an IIN; an IIN is a BIN.) ANSI can be contacted through its web Web address: xxx.xxxx.xxx/. xxx.xxxx.xxx. The National Council for Prescription Drug Programs (NCPDP) issues the RxPCN. For TrOOP Facilitation routing, you can use a new RxPCN or obtain and use an additional RxPCN in lieu of an additional RxBIN. The NCPDP can be contacted through its web Web address: xxx.xxxxx.xxx. 4.3 Testing the Data Exchange Process‌ After all file transmission testing has been completed to the satisfaction of both the SPAP Data Sharing partner and CMS, the partner may begin submitting its regular production files to the BCRC, in accordance with the provisions of Sections C and D of the SPAP Data Sharing Agreement. In order to test the process for creating an Update File, a test “Update” shall be prepared by the partner and include data regarding individuals identified in the Test File. The partner shall submit the test Update data within ninety (90) days after receipt of the test Response File. The Test File Update shall include any corrections made in the previous Test Response File sent to the partner by the BCRC. For full file replacement, any corrections made to a file will fully replace what was previously submitted by the Partner. Upon completion of its review of the test update, the BCRC shall provide the partner a Response for every record found on the Test Update File. The BCRC shall provide a Test Update Response File to the partner, within a week, but no longer than forty-five (45) days after receipt of the partner’s Test Update File. Once the BCRC and the SPAP partner have completed all file transmission testing to the satisfaction of both parties, the partner may begin submitting its regular production files to the BCRC.