X12 electronic billing standards are gaining pharmacy supporters – Chain Pharmacy
James Frederick
ALEXANDRIA, Va. — The American Society of Health-System Pharmacists is the latest in a growing list of national pharmacy groups to announce its support or the electronic billing standard for pharmacist professional services known as X12.
X12 is an organization accredited by the American National Standards Institute to develop uniform standards for electronic data exchange including health insurance claims such as professional pharmacy claims. “An example of such a data exchange,” noted an organization statement, “would be a pharmacist submitting health care claim information electronically to the proper insurance carrier or government agency to be compensated for services provided to patients, information previously communicated via a HCFA-1500 paper form.”
Daniel Coaugh, an ambulatory care associate for ASHP, explained the group’s support for the effort byXl2 to develop EDI billing standards. “The X12 Pharmacy Advisory Panel’s active involvement with the development of new electronic-billing standards is crucial to enabling pharmacists to bill for their professional services in every practice setting,” he said.
Several other pharmacy groups, including the National Community Pharmacists Association, the American College of Clinical Pharmacy, the American Pharmacists Association and the American Society of Consultant Pharmacists, already have come out in favor of the X12 standards. Conspicuous in its absence is the National Association of Chain Drug Stores, which last year proposed its own set of guide lines f or electronic billing of pharmacist services.
Mary Ann Wagner, vice president of pharmacy regulatory affairs for NACDS, explained in an interview late last year that NACDS’ reluctance to join the organization stemmed in part from concerns that “X12 is for billing services that would be charged as a medical benefit” rather than as a pharmacy claim. She and other pharmacy leaders have expressed the fear that X12 electronic billing standards could classify certain disease state management services that pharmacists already perform as medical benefits instead of pharmacy benefits, potentially denying pharmacists the right to bill payers for those services.
Nevertheless, Wagner said NACDS hadn’t ruled out the possibility that it would join the X12 group to help shape the search for a standardized electronic billing procedure.
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