Regulations: Requirements regarding use of identification cards and devices to process claims for prescription drugs and devices.
1. If a health care plan that provides coverage for prescription drugs or devices issues a single identification card or other device to an insured that contains information solely needed to process a claim for a prescription drug or device, the card or other device must conform to the requirements of the National Council for Prescription Drug Programs set forth in the NCPDP Pharmacy ID Card Implementation Guide that are consistent with applicable regulations adopted pursuant to the Health Insurance Portability and Accountability Act of 1996, Public Law 104-191, as they may be amended from time to time, or must contain at least the following elements:
(a) The name or logo of the administrator issuing the card or device.
(b) The insured’s identification number, which must be displayed on the front side of the card or device.
(c) The name and address of the administrator to which prescription claims that are not processed electronically or correspondence should be sent.
(d) The telephone number that providers may call for assistance concerning pharmacy benefits.
(e) Complete information concerning routing of electronic transactions, including, without limitation, the international identification number and, if required by the administrator to process the claim, the processing control number and group number.
ĘThe information on the card or device must be arranged in a manner that corresponds both in content and form to the content and form required by the plan to process the claim.
2. The Commissioner shall adopt such regulations as are necessary to carry out the provisions of this section.
3. As used in this section:
(a) “Administrator” has the meaning ascribed to it in NRS 683A.025, and includes a pharmacy benefits manager.
(b) “Health care plan” has the meaning ascribed to it in NRS 679B.520.
Last modified: February 27, 2006