/ DERF #:
ECL #:
RECEIPT DATE:
WG MEETING DATE(S): / FINAL DERF RESOLUTION
DERF ECL Emergency ECL
Approved – No Modifications
Approved – With Modifications
Denied
Pended 1 2 3 (No further action)
Withdrawn
DERF/ECL INSTRUCTIONS
Please refer to the following instructions when completing this DERF/ECL form. Use additional attachments when necessary to provide complete information. Incomplete forms will be returned for additional information prior to processing. This form is used for multiple purposes: 1) To add/modify a data element to the Data Dictionary, 2) To add/modify a data element value to the External Code List (ECL), 3) To add/modify information in a standard or implementation guide, 4) To bring forward a new standard or implementation guide.
References other SDO Data Dictionary (list SDO, standard and version):
NCPDP Standards/Implementation Guides: Indicate which standards(s) are impacted by this request
Audit (E) / Financial Infor. Reporting (N) / Post Adjudication (A) / Specialty Pharmacy (C)
Batch (B) / Formulary & Benefit (F) / Prescription Transfer (V) / Telecommunication (T)
Batch Standard Subrogation (O) / Manufacturer Rebates (R) / Prior Authorization Transfer (X) / UCF/WC UCF ( Z/W)
Benefit Integration (I) / Medicaid Subrogation (G) / Product Identifiers / Uniform Healthcare Payer Data (Y)
Billing Unit (U) / Medical Rebates (J) / Retiree Drug Subsidy (L) / XML Standard
Data Dictionary / Operating Rules (K) / SCRIPT (S)
External Code List / Pharmacy/Combo ID Card (H) / Specialized (Q)
Describe the business need or purpose addressed by this DERF/ECL submission (required): This section should explain, in detail, what the requester would like changed, added, or deleted and the reasons why the modifications are necessary. The written explanation should give the readers an understanding as to what the requester is attempting to accomplish.
New data element - Use this section to indicate the proposed field name, the size (length, including decimals, if applicable), and the format (e.g. numeric, alpha/numeric, dollar). Include a definition of the field. If applicable, every value/code requested must contain a definition. Specify the situation in which this new field would be used. Fill out Transaction Usage section next.
Proposed Name or XML tag (required):
Size (required): / Format (required):
Segment for the New Data Element (required for Telecom or XML-based standard):
Definition (required):
Codes/Values – every code/value must include a definition (Use attachments if necessary): (Staff will determine actual code or value)
Value Suggested / Value Description and Definition (required)
/ Value Limitations (not required)
Number of Repetitions for New Data Element (required if repeating data element):
Reject Codes – Add new reject codes associated with the new data element. (Staff assigns all values and creates standard reject codes for new fields.)
Value Suggested / Value Description (required) / Value Limitation or Explanation (not required)
Change existing data element (All information is required for changes) To change a data element, complete this section, indicating the current Data Dictionary/ECL element information. For applicable standards, list the Field Number and ID from the Data Dictionary. Check what information is changing (e.g. field size (length), format (numeric, alpha/numeric, dollar), adding or changing a value, field name or definition). Summarize all changes that are being requested. Fill out Transaction Usage section next.
Field Number : / ID: / Name or XML tag:
Requested change to (choose at least one): / Size / Format / Values / Definition / Name
Limitations to change: (i.e. “Used in Versions XX and above.”)
Summarize Proposed Changes (Use attachments if necessary):
Codes/Values – every code/value change must include a definition (Use attachments if necessary):
Value Suggested / Value Description and Definition (required) / Value Limitations (not required)
TELECOMMUNICATION STANDARD ONLY
REQUESTING EMERGENCY ECL CHANGE associated to Regulatory/Legislative Compliance
EMERGENCY ECL REQUESTS PERTAIN ONLY TO THE TELECOMMUNICATION STANDARD. Used for regulatory and legislative changes which require the addition of a value(s) to be implemented prior to the scheduled annual implementation date of the next ECL Publication. If approved, the request will appear in the next ECL publication. There will be a minimum of 180 days required before the implementation of an emergency ECL change. Please refer to the Publication Release/ Implementation Dates Chart in the Emergency Telecommunication External Code List Value Addendum. / Reason for Emergency Change / Reference to Regulation or Legislation:
Date Needed By:
(no earlier than 180 days from the ECL Publication)
Transaction Usage- Which transaction(s) is the field used in? (Use attachments if necessary): (required for Telecom or Batch Standard)
Standard / Indicate Transaction(s)/File Used / If Used, Situation must be provided.
Audit
Batch
Batch Standard Subrogation
Benefit Integration
Financial Information Reporting
Formulary and Benefit
Manufacturer Rebates
Medicaid Subrogation
Medical Rebates Data Submission
Post Adjudication
Prescription Transfer
Prior Authorization Transfer
Retiree Drug Subsidy
SCRIPT / NewRx
RxRenewalRequest/Response
RxFill
RxFillIndicatorChange
CancelRx
CancelRxResponse
GetMessage
RxChangeRequest/Response
RxHistory Request/ Response
CancelRx and NewRx
Resupply
Recertification
DrugAdministration
NewRxRequest
NewRxResponseDenied
PAInitiationRequest/Response
PARequest/Response
PAAppealRequest/Response
PACancelRequest/Response
PANotification
RxTransferRequest/Response
RxTransferConfirm
REMSInitiationRequest/Response
REMSRequest/Response
Specialized / Census
MTMServiceRequest/Response
MTMService Documentation
ClinicalInfoRequest/Response
CFInventoryList
CFProductInquiry/Response
CFRxOrderRequest
CFRxOrderCompletion
CFRxOrderCancel
CFManifest
Specialty Pharmacy Data Reporting
Telecommunication / Eligibility Verification
Claim Billing/Rebill/Encounter
Service Billing/Rebill
Predetermination of Benefits
Claim Reversal
Service Reversal
Prior Authorization Request and Billing (Claim)
Prior Authorization Request and Billing (Service)
Prior Authorization Reversal (Claim)
Prior Authorization Reversal (Service)
Prior Authorization Inquiry
Prior Authorization Request Only (Claim)
Information Reporting/Rebill (Claim)
Information Reporting/Rebill (Service)
Information Reporting Reversal (Claim)
Information Reporting Reversal (Service)
Uniform Healthcare Payer Data
XML Standard (Required) / Transport Transactions
Error
Status
Verify
Get Message
(This Section Must Be Completed)
Submitter
Name: / Task Group submitting DERF (if applicable):
Title: / Fax:
Company: / email:
Address:
City/State/Zip: / Phone:
Signature: / Date:
For MC Maintenance and Control Use Only
Work Groups that may be impacted (check all appropriate boxes):
WG1 Telecommunication / WG14 Long Term Post Acute Care
WG2 Product Identification / WG16 Property and Casualty/Workers’ Compensation WG16 Property and Casualty/Workers’ Compensation
WG7 Manufacturer & Associated Trading Partner Transaction Standards / WG18 Specialty Pharmacy
WG9 Government Programs / WG45 External Standards Assessment, Harmonization, and Implementation Guidance
WG10 Professional Pharmacy Services / MC Maintenance and Control
WG11 ePrescribing & Related Transactions WG11 ePrescribing & Related Transactions / Other
Return completed form by email, mail or fax:
NCPDP, 9240 E. Raintree Drive, Scottsdale, Arizona 85260-7519
email w fax (480) 767-1042 w phone (480) 477-1000
This section is used by NCPDP Staff Only
DERF MODIFICATIONS (Actions Taken by WG(s) Review)WG
DERF/ ECL STATUS:
Approved/Reviewed with no modifications
Approved/Reviewed with modifications (complete modifications below)
Pended by work group
Reason:
Denied by Work Group
Withdrawn by submitter
Changed ECL to DERF (also check appropriate DERF status)
Reason:
Vote / Pink / Yellow / Green / Total
Approved
Opposed
Modifications:
MC
DERF/ ECL STATUS:
Approved/Reviewed with no further modifications
Approved/Reviewed with further modifications (complete modifications below)
Pended by work group
Reason:
Denied by Work Group
Withdrawn by submitter
Changed ECL to DERF (also check appropriate DERF status)
Vote / Pink / Yellow / Green / Total
Approved
Opposed
Modifications:
Revised: June 2018 Page: 1