Category Archives: EDI

NCPDP Learning Resources

NCPDP (National Council for Prescription Drug Programs) telecommunication standard specifies the format of pharmacy claims and other pharmacy-related transactions.

NCPDP is a quirky legacy format that would feel alien to any modern-day developer or an IT person.

For example, it uses non-printable separators and non-mnemonic two-character field identifiers; it relies on an obscure way to encode numbers with decimal points; it uses a mixture of variable and fixed length fields.

Nevertheless, the format is still widely used in the pharmacy space.

We published several posts to help anyone dealing with this pesky format quickly get up to speed:

Finally, we provide a completely free NCPDP viewer and file reader to help you make sense of your NCPDP files.

EDI and NCPDP Viewers and APIs

EDI is a legacy data format that is still widely used today for many business transactions, such as business orders and invoices. It is also a de-facto standard, endorsed by HIPAA, for transmitting administrative healthcare data, such as claims and payments.

There are several flavors of EDI; X12 EDI is used in the US. This post provides a good introduction to X12 EDI.

DataPower gateways have a B2B feature that enables the processing of X12 EDI.

We’ve developed several free tools to help deal with X12 EDI, especially when it comes to healthcare-specific EDI transactions. The tools are available from our sister website, Healthcare Data Insight, along with many examples and tutorials.

Our tools also provide support for the NCPDP telecommunication format. NCPDP is the format (and the standard) used for pharmacy claims and related transactions in the pharmacy space. The NCPDP format conceptually resembles X12 EDI but uses completely different separators and data elements.

Here is our list of free EDI and NCPDP tools:

  • X12 EDI viewer and file reader. The viewer converts any EDI input into a user-friendly format.
    It provides a special business view (without EDI artifacts) for 837 (healthcare claim) and 835 (payment) transactions.
    The viewer automatically decodes CPT, ICD-10, NDC, and other healthcare codes so that you can immediately see a code’s description. You can find multiple examples of the viewer in action here.
  • NCPDP viewer and file reader. The NCPDP viewer shares the user-friendly UI with our X12 EDI viewer and provides similar functionality adapted for the NCPDP format.
  • API to convert 837 and 835 X12 EDI transactions. This free API consumes X12 EDI text and returns a claim or a payment business object. The schema of business objects is intuitive; it requires no knowledge of X12 EDI.
  • API to convert text in NCPDP telecom format into JSON.

We also provide a free healthcare code lookup tool to make it easy to decipher healthcare codes, such as CPT, ICD-10, NDC, UB-04, and others.