NCPDP developed a set of transactions that provides a record of a payment, by a plan supplemental to Part D, to a Part D Plan. The transaction set utilized is the Information Reporting Transaction (aka Nx Transaction). This transaction can be utilized for multiple types of information reporting, however, to distinguish those used for purposes of Part D coordination of benefits with supplemental payers, the Field 11Ø-AK (SOFTWARE VENDOR) located in the transaction header will always contain the value “TROOP”. For more information on the Nx format, see D0 CMS Real-Time N Request and Response Transaction Specifications, which can also be found under the Related Documents section of this page.

Nx Process Flow

The use of the Nx transaction for Part D coordination of benefits follows a CMS/Industry required process that involves additional data elements and transactions as noted below in the flow:

Nx and CMS Part D Coordination of Benefits

Part D Plans are required under CMS Part D Manual Chapter 14 to process and respond to Nx Transactions, apply the amount of other payer payment (calculated by subtracting the supplemental patient pay amount from the Part D Plan patient pay amount) toward TrOOP and coordinate benefits from any supplemental payer if the status of the claim has changed.

Through industry learning it was determined that there are situations where a Part D Plan may not be able to successfully process an Nx transaction due to eligibility timing delays or other issues. In order to accommodate these situations, some Nx transactions will be retried or followed-up. For more information on Part D Plan rejected transactions that will be retried or followed-up see Part D Plan Rejected N Transaction Follow-up and Retry Process, which can also be found under the Related Documents section of this page.

Nx Transactions and HIPAA

While the Nx transaction is not a named HIPAA transaction, data elements used in the Nx transaction are derived from fields that are covered under HIPAA.

To understand what fields are utilized when creating the Nx transaction see B Transaction Fields Utilized in N Transactions, which can also be found under the Related Documents section of this page.

For more information on which fields must be HIPAA compliant in order for the transaction to qualify for the coordination of benefits process see HIPAA Compliance Fields for Alpha Num With B to N Realtime for NCPDP, which can also be found under the Related Documents section of this page.