To assist State Pharmaceutical Assistance Programs (SPAP) and AIDS Drug Assistance Programs (ADAP) in monitoring their supplemental claims and whether the Transaction Facilitator is able to find an eligibility match we have created a bi-monthly report that runs on the 1st and the 15th of each month.
The list of SPAP/ADAP BIN/PCNs reported is based on the NCPDP SPAP/ADAP BIN/PCN list. This is a self-reported list. The list of SPAP/ADAP BIN/PCNs is provided by CMS.
Field definitions for the SPAP/ADAP Bi-Monthly Report:
BIN – The Bank Identification Number for the transactions being reported. Note that CMS requires all SPAP/ADAPS to have a unique BIN or BIN/PCN for all Part D eligibility beneficiaries for their supplemental plan.
PCN – The Processor Control Number for the transactions being reported. Note that CMS requires all SPAP/ADAPS to have a unique BIN or BIN/PCN for all Part D eligibility beneficiaries for its supplemental plan.
Replay number – Indicates whether count was the original count or a replay because an eligibility match could not be found due to file submission timing. See SPAP/ADAP Follow-up Process for more information.
Version – This indicates what NCPDP version the claim was transmitted in (note as of July 1, 2012 all claims should be in D.0).
Type –
Q* B count – The count of transactions received by the Transaction Facilitator for the BIN/PCN for the quarter notated. *represents the calendar quarter (1-4)
Q* P count – The count of transactions received that met the criteria allowing an attempt to match eligibility and generate an N, for the quarter notated. *represents the calendar quarter (1-4)
The difference between the Q*B Count and the Q*P Count represent claims that should not be forwarded to the Part D Plan. These include claims that:
1. Do not contain a COB segment
2. Have parsing errors
N* Count – The count of transactions for which an N was generated and transmitted to the Part D plan. *represents the calendar quarter (1-4). This is the number of Q*P transaction for which the Transaction Facilitator was able to find:
- a match for the BIN/PCN/Cardholder ID in the Other Health Insurance Record on the CMS eligibility File
- an active Part D Plan for the beneficiary for the date of service on the transaction
Q*Rate – the percent of qualified (*Q*P) transactions for which an N was able to be generated and transmitted to the Part D Plan. *represents the calendar quarter (1-4)
B Count – YTD count of all transactions received by the Transaction Facilitator for the BIN/PCN
P Count – YTD count of transactions received that met the criteria allowing an attempt to match eligibility and generate an N
N Count – The count of transactions for which an N was generated and transmitted to the Part D Plan
Rate – YTD percent of qualified (P) transactions for which an N was able to be generated and transmitted to the Part D Plan