The NCPDP membership is requesting a new standard be named in HIPAA for use in the pharmacy industry – the Medicaid Subrogation Standard Implementation Guide, version 3.Ø.

Medicaid Subrogation is a process whereby Medicaid is the payer of last resort. The state has reimbursed the pharmacy provider for covered claims and now is pursuing reimbursement from other payers for these claims. Some states may choose to “Pay” all claims in full, through a federal waiver, at the point of receipt and “Chase” reimbursements from responsible third parties after the fact.   The Medicaid Subrogation transactions use the Telecommunication Standard transactions.

More information on this business function is found in the NCPDP “Medicaid Subrogation Implementation Guide”.