State_Encounter_Requirements

Pharmacy Medicaid Encounter Requirements and Information by State

Please be patient while I work to get this table filled in.
So far, the only states I have architected pharmacy encounter systems for are

• Arizona
• Florida
• Indiana
• South Carolina
• Ohio
• New Jersey
• Wisconsin

A Note About These Documents

Keep in mind that these are examples of companion guides for each state. Different health plans within the same state may receive encounters in slightly different formats and combine them with medical encounters or modify them before sending them through the state. Also, the companion guide is just the beginning to help see how to get started. There are also response files formats and other file formats which may or may not be included in a companion guide.

Most of these are NCPDP based, and you can see how there are slight differences between plans who claim to use the same standard. I believe Georgia is the one plan I have found which deviates the furthest from the NCPDP 5.1 standard. Some have batch ID's which cannot be repeated, while others may require a single batch ID for every encounter file. I don't know why that is the case, but they apparently differentiate the file by creation date or size or file name or some other feature of the file.

Thank you!!!

Companion Guides and Pharmacy Encounters Documents by State

Note: These sites change frequently, so I am beginning to move the links up to the parent web sites rather than giving a link to a specific document. The downside of this is that you may have to look through various menu selections to get the document you are looking for. The positive side of it is that you may find other helpful information as well.

For pharmacy encounters, you may want to look for selections such as Pharmacy, NCPDP, Encounters (but only pharmacy encounters as opposed to 837's for medical, optical, and other types of encounters), payer sheet, companion guide, etc.

Alabama	Alaska	Arizona	Arkansas	California?
Colorado?	Connecticut?	Delaware?	Florida	Georgia?
Hawaii?	Idaho?	Illinois?	Indiana	Iowa?
Kansas?	Kentucky?	Louisiana?	Maine?	Maryland?
Massachusetts?	Michigan	Minnesota	Mississippi?	Missouri?
Montana?	Nebraska?	Nevada?	New Hampshire?	New Jersey?
New Mexico?	New York	North Carolina	North Dakota?	Ohio?
Oklahoma?	Oregon	Pennsylvania	Rhode Island?	South Carolina?
South Dakota?	Tennessee	Texas	Utah?	Vermont?
Virginia	Washington	West Virginia?	Wisconsin?	Wyoming?

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