SES Prescription Routing v10!6!121713

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EDUCATION.
Prescription Routing v10.6, including EPCS
Presented by:
Implementation Team

Agenda
Getting Started
Surescripts Services
Prescription Routing v10.6

Setup in the Surescripts Staging Environment
Directories v4.6
Overview
Prescription Routing Messages & Requirements
Controlled Substance Handling
Segment Overview
Responsibilities & Timelines

Surescripts Services
Getting Started

Surescripts helps connect

Prescriber
vendor networks
Hospitals
Independent and
chain pharmacies
Rhode Island Department

of Health (H1N1 monitoring)
Competitor
networks
Health plans
and PBMs
Prescribers
Medicaid
250+ Surescripts certified

prescriber systems
The countrys largest

physician groups
and clinics (130)
Mail order
pharmacies

Surescripts Core Services
Electronic
new /
renewal
prescriptions
Full
control
Prescription
of your
Benefit
brand
and
business
Access to 220M+
member records
nationwide
Prescribed
medications
in ambulatory
/acute care
settings
Improved Safety
Reduced
Cost
Immediate
Increased
Engage in
and direct
Prescription
Prescription
new ways
Efficiency
access
to
Routing
History
with
users
user base

Todays Presentation [1]

Audience
Prescriber Technology Vendors (prescriber types)
Pharmacies and Pharmacy Technology Vendors (pharmacy types)

Participants who have partnered with Surescripts Implementations Team
Participants who have elected for a self-driven implementation
Participants who will certify on v10.6 without EPCS

Participants who will certify on v10.6 with EPCS
Current or existing Participants who will make account/portal upgrades

Todays Presentation [2]
This education series has been designed to highlight important

implementation points and FAQ in order to help ALL Participants jump start
their Prescription Routing project
Variations specific to your account should be discussed with your

Account Manager/Account Executive/Implementation Project Manager
Use this presentation along with the implementation documentation
References back to the Surescripts Guides

[PR x.x] = Surescripts Prescription Routing v10.6 Implementation Guide section
[ACR106R-xxx] = Surescripts v10.6 Implementation Guide Application Certification
Requirement
[DIR x.x] = Surescripts Directories v4.6 Guide section

Surescripts Professional Services

Surescripts Professional Services consists of a team of expert Implementation
Project Managers (IPMs). We are here to help reduce uncertainty within your project,
save you time, and provide your team with tools, knowledge and expertise weve
developed through hundreds of implementations.
As of November 19th, 2012, we are pleased to offer two core packages at fixed
prices, which you may choose from based on your organizations specific needs,
should you wish to leverage the knowledge and expertise of this team. You may
chose different service levels for different projects as desired:
Premier Service Package
Dedicated Resource
Project Management, Planning
Expert Consultation
In-Depth Certification Preparedness
Testing
Basic Service Package

Access to Implementation Expertise
Basic Certification Preparedness Testing by
an available member of the Professional
Services Team
To sign up for services, or for more information (including pricing), please contact
your Surescripts Account Executive

10
Product Overview

11
Todays Presentation
New Prescription
Refill Renewal Request and Response

Rx Change Request and Response
Cancel Rx Request and Response
Status, Error, Verify
Key New Features
Electronic Prescribing of Controlled Substances (EPCS)
Structured SIG: Surescripts will work with Participants willing to pilot the Structured
SIG and will make product recommendations following the pilot.
Use of Federal Medication Terminologies (FMT)

Requiring Communication Numbers
Provider (PVD) loops increased from 3 to 4
Date/Time Modifications to include additional information

12
Required for Certification

Prescription Routing 10.6 Messages
(Sender and Receiver)
Requirement
NewRx
Required
Refill Renewal Request
Required
Refill Renewal Response
Required
Rx Change Request
Optional
Rx Change Response
Optional
Cancel Rx Request
Optional
Cancel Rx Response
Optional
Status
Required
Error
Required
Verify
Required
All partners shall*106R-011 be able to accept freestanding ERROR messages from network participants and transport down to the
end users (if error requires end user notification or action).
Participants shall*106R-012 support the following scenarios in their application workflow (see section 3.4 for each workflow).
An ERROR message shall*106R-014 never be responded to with an ERROR message; this could create an endless loop.
EPCS is not a transaction type; it is a service level that is optional
All applicable shall* requirements in the Prescription Routing guide are required
13
Project Documentation
NCPDP SCRIPT v10.6 guide and External Code List October 2008. Join
today at http://ncpdp.org to get involved and obtain copy of the NCPDP
documentation
Welcome email includes a zip file
Review the README file within the zip file
Adherence to the documentation is required for certification

14
Setup in the Surescripts Staging

Environment
Getting Started

15
Connectivity
Carefully review the information in the Surescripts Connectivity
Questionnaire
FQDN and IP Requirements include:
Participants must use Surescripts FQDN with public Domain Name System (DNS) lookups
Participants must add the Surescripts IP addresses for the secondary data center for all
Surescripts environments into their firewalls
The systems that make connections into the Surescripts network must utilize a public U.S.
based IP address
Separate Participant source IP addresses for traffic destined to Surescripts Staging and
Production must be established.
Certificate Requirements include:

Certificate Common Name must match the FQDN provided in the URL
Certificate must be signed by a public Trusted Root Certificate Authority (CA) with a minimum
2048 bit Public Key.
Surescripts Active/Active Data Centers
Surescripts URLs, IPs, and Ports

16
Setup for Existing Participants [1]

Existing Participants = Those that currently have a staging Prescription
Routing account, portal, and access to the Surescripts Admin Console
You will be updating your Directories and Prescription Routing versions
Directories v4.6
Delimited flat file via DirectoryDownload
The files are generated at an account level
The file format is not backwards compatible
Previous versions of directories were flat, fixed-length files. The 4.6 version is a delimited
file
All web service functions

Must send all web service calls to a new URL
Must send all web service calls in the v4.6 format once changes are made

17
Setup for Existing Participants [2]

Prescription Routing v10.6 Portals
Option 1: Keep existing portal, but update portal configuration
A big bang or hard cutover approach
All connectivity info, URLs, and basic authentication credentials will remain unchanged
Option 2: Add a new portal where existing portal(s) will continue to run in
parallel for a limited timeframe
Allows for a migration or phased approach
Participant must manage and migrate pharmacy/prescriber directory records
New connectivity info, URLs, and basic authentication credentials will be applied to the
v10.6 portal

18
Getting Setup in the Staging Environment

Fill out and return the Surescripts Connectivity Questionnaire located in your
welcome packet
Participants who have partnered with Surescripts Implementations Team will work
directly with their Implementation Project Manager
- OR -
Participants who have elected for a self-driven implementation

Submit your form to implementationsupport@surescripts.com
Please allow two weeks to process your setup request; you will receive your connectivity
information via email once your setup is complete
You are responsible for verifying the connection has been fully established
To engage with Implementation Services:

For existing clients, your Account Manager or Account Executive can help you engage with
Implementation Services

19
Directories v4.6
Directories

20
Overview
The Surescripts Directory is essential for prescription messages to flow on
the network
Both prescriber and pharmacy must be registered in the Directory
Must also be Active
Must also have the correct Service Levels
Two ways to change directory entries:

Using the Surescripts web-based Administration Console
Using directory web services
During certification testing, the Participant must demonstrate:

Download the appropriate directory and apply to your local system
Apply Surescripts Directory updates to your local system within 24 hours of

downloading any new or updated prescriber/pharmacy information
Ability to add/change/activate/deactivate prescribers or pharmacies in a timely
manner if implementing web services
See the Directory Certification Test Scenarios document for details
21
Changes for Directory 4.6

Directory 4.6 download file formats are changed from fixed width to
pipe-delimited (|), allowing for future enhancement with minimal
impact.
Service Level is no longer a bit string, and is now a repeating loop
where the pharmacy or prescribers messaging capabilities are
indicated.
<ServiceLevels>
<ServiceLevel>
<ServiceLevelName>ControlledSubstance</ServiceLevelName>
</ServiceLevel>
<ServiceLevel>
<ServiceLevelName>New</ServiceLevelName>
</ServiceLevel>
<ServiceLevel>
<ServiceLevelName>Refill</ServiceLevelName>
</ServiceLevel>
</ServiceLevels>
22
Changes for Directory 4.6, continued

Introduced the concept of Organizations which represent senders
and recipients of messages on the network when those messages
are not directed to a specific individual.
This supports messaging on the Surescripts network such as Clinical Messaging.
Organizations are further defined by Type. Pharmacy became a type of
organization, as did Payer.
Geocoded Addresses are now available for providers and

organizations
Downloads always contain both the vendor submitted address and
the standardized address, including the geocoding.

23
Common Message Header

Directory message wrapper [DIR 4.2] is different from Prescription Routing
messages
ELEMENT
M/C
COMMENT
<To>
SSDR46.dp@surescripts.com (Directories v4.6 TO address)
<From>
The Data Provider ID or identification of the sender of the message. A network

participant ID (e.g. XXX001.dp), provided by Surescripts for each account
<Username>
<Password>
Directory Messaging uses username and password whereas Routing

Messaging uses basic authentication. User ID with permissions to update
directories, provided by Surescripts. You may use the same username
assigned to your organization to access the Admin Console.
Base64 encoded, SHA1 hash of the UTF-16 encoded password. All
passwords are upper case. You may use the same password assigned to
your organization to access the Admin Console; however Admin Console
users are required to change their password every 90 days, so this password
should not be hard coded.

24
v4.6 XML Wrapper / Header

Version and schema example:
<?xml version=1.0 encoding=utf-8?>
<Message xmlns=http://www.surescripts.com/messaging
xmlns:xsi=http://www.w3.org/2001/XMLSchema-instance version=004 release=006
xsi:schemaLocation=http://www.surescripts.com/messaging
SS_Directories_4_6_External.xsd>
<Header>
<To>mailto:SSDR46.dp@surescripts.com</To>
<From>mailto:xxxxxx.dp@surescripts.com</From>
If you are upgrading from a previous version, you will have the following
changes to the header:
New version information
New XSD file information
New <To> ID; and you will post directory messages to a new URL

25
Functions and Elements

Message function and elements are defined within body of the directories
message
Function name calls out the type of message to be executed (i.e. Directory
Download, Add Prescriber, Update Pharmacy, etc.)
Message elements define entity to be added or updated

Prescriber Element [DIR 6.2]
Account and Portal a prescriber is assigned to
Identification values for prescriber (i.e. DEA, NPI, State License, etc.)
Full name and demographic information
Organization Element (previously known as Pharmacy in lower directory versions

4.6) [DIR 8.2]
Account and Portal a pharmacy is assigned to
Identification values for pharmacy (i.e. NCPDP, etc.)
Pharmacy name and demographic information

26
Directory Download Functions

DirectoryDownload / DirectoryDownloadResponse
Required for certification
Response will include the name of the directory download flat file
See sample download code (how to grab the file) [DIR 9]
Participants shall download new directory entries nightly and apply to end
user within 1 business day
Participants shall*46D-012 automate the process to download new and
updated directory information within 24 hours.
Participants shall*46D-013 have a process to ensure that all endpoints
successfully receive the downloaded information within 24 hours.
Participants cannot block/reject an incoming prescription message based
on local directory information

27
Pharmacy Functions
AddOrganization / STATUS or ERROR [DIR 8.1 / DIR 6.9]
Required of pharmacy types for certification in case implementing web services
Use AddOrganization to add a new pharmacies to your account
System will check for duplicate NCPDP # and NPI # (required in v4.6) will be
validated using the Luhn algorithm in both the Surescripts staging and production
environment
UpdateOrganization / STATUS or ERROR [DIR 8.4 / DIR 6.9]

Required of pharmacy types for certification in case implementing web services
Will override (set to null or default) any optional element that is not included in the
update message; recommend you:
Run GetOrganzation first
Use the GetOrganizationResponse as a base for your UpdateOrganization message

Run UpdateOrganization message
To completely disable a record

Set <ActiveEndTime> = a date in the past, and
Send empty <ServiceLevel>
For those who are setting up parallel portals use this function to move a record
from your current portal to your new v10.6 portal
28
Prescriber Functions [1]

AddPrescriber / AddPrescriberResponse, AddPrescriberLocationResponse
or ERROR [DIR 6.1 /DIR 6.3 / DIR 6.9]
Required of prescribing types for certification in case implementing web services
Use AddPrescriber to add a new provider to your account
Prescribers should not be registered in our directories until they have been identity proofed
by the participant in production. ID proof attestation is required by Surescripts per
guidelines such as NIST Special Publication 800-63
System will check for:

NPI # will be validated using the Luhn algorithm in both the Surescripts staging and
production environment
Duplicate NPI # / DEA #
A duplicate will result in an ERROR
Use AddPrescriberLocation instead

29
Prescriber Functions [2]

AddPrescriberLocation / AddPrescriberLocationResponse or ERROR [DIR 6.4 / DIR
6.5 DIR 1.11]
Required of prescribing types for certification in you are implementing web services
Use when the prescriber already exists in the directory under your account; must submit SPI
root (first ten digits)
Add additional locations and DEA #
UpdatePrescriberLocation / STATUS or ERROR [DIR 2.3, DIR 1.11]

Required of prescribing types for certification in you are implementing web services
Will override (set to null or default) any optional element that is not included in the update
message
Run GetPrescriber first
Use the GetPrescriberResponse as a base for your UpdatePrescriberLocation message
Run UpdatePrescriberLocation message
To completely disable a record

Set ActiveEndTime = a date in the past, and
Send empty ServiceLevel
For those who are setting up parallel portals use this function to move a record from your
current portal to your new portal

30
Application Certification Requirements

Participant must update their end user systems within 24 hours of
downloading any new or updated prescriber/pharmacy information from
Surescripts. The participants can download this information either using the
Surescripts Admin Console or through Web services via an automated
process. If the participant uses Web services; then the following message
types shall be supported:
Pharmacy Types: AddOrganization, UpdateOrganization, and Directory download
(Full and Nightly).
Prescriber Types: AddPrescriber, AddPrescriberLocation,

UpdatePrescriberLocation, and Directory download (Full and Nightly).
In the event a participant has local prescriber/pharmacy directory

information in addition to the Surescripts prescriber/pharmacy directory
information, the participant shall*464D-005 utilize the Surescripts
prescriber/pharmacy directory information for all prescriptions routed
through the Surescripts network.
See the Surescripts Directory Guide for more information and
additional application certification requirements
31
Directory Requirements
Pharmacies:
At this time, we are not tying any specific version of Directories with 10.6, retail
pharmacies can remain on their current version
Pharmacies must move to Directory 4.6 when they implement EPCS to support this
feature
Prescriber Vendors:
Must be on Directory 4.6 to implement NCPDP Script 10.6 (regardless of when they
plan to implement EPCS). This is necessary to distinguish mail from retail
pharmacies
Previous versions do not support data elements required for use in 10.6 to meet
specific application certification requirements related to mail and retail

32
Prescription Routing Messages &

Requirements

33
Core Prescription Routing Messages [1]

Required of all Participants for certification
NEWRX [PR 5.1]
REFREQ [PR 5.2]
REFRES [PR 5.3]
Message direction?
Prescriber to
Pharmacy
Pharmacy to
Prescriber
Prescriber to
Pharmacy
What is it used for?
Prescriber
originated
prescription
message sent to
the patients
pharmacy of choice
Request additional
fill authorizations
for a previously
communicated
prescription
(electronically,
paper, fax, or
phone)
Used to
communicate
authorization or
denial of a refill
request back to
pharmacy

34
Core Prescription Routing Messages [2]

Identifies:
Prescriber
Pharmacy
Patient
Medication Prescribed
Medication Dispensed (Renewals Only)
May also include:
Prescriber Supervisor
Codified SIG
Observation
Coordination of Benefits
Request (LTCPAC Only)
Facility
EDIFACT and XML sample transactions [PR 9]

35
State Regulatory Requirements

Please make sure you have researched and covered all State guidelines
regarding electronic prescribing.
Special Cases of state guidelines requiring State Approval Prior to
Commencement of E-prescribing Operations
Nevada: Physician e-prescribing application vendors (only) are required to apply to the Nevada State Board of
Pharmacy prior to operating in the state. Please see: http://bop.nv.gov/resources/ALL/Approved_EPrescribing_Systems/
Ohio: All physician and pharmacy vendors that intend to engage in e-prescribing transactions in the state must
apply to the Ohio Board of Pharmacy and be given approvable status by the board prior to doing so. Please
see: http://pharmacy.ohio.gov/Documents/Pubs/Special/Electronic%20Prescription%20Transmission%20System
s.pdf (Note: This requirement does not apply to networks such as Surescripts.)
Washington State: All physician vendors, pharmacy vendors, and electronic gateways must be approved by the
Pharmacy Quality Assurance Commission prior to engaging in e-prescribing transactions in the state. Please
see: http://www.doh.wa.gov/Portals/1/Documents/Pubs/ElectronicRx.pdf (Note: Surescripts is an approved
electronic gateway in Washington.)

36
General Application Certification Requirements

The application shall [106R-004] provide differentiation of all new
messages that require user attention. Provide users with access to the
most recent acknowledgement information (STATUS 000, STATUS 010,
ERROR, or VERIFY) for all messages the user initiates [106R-005]
The participant shall*106R-006 be able to process incoming, syntactically

valid maximum and minimum population messages. Optional data
elements (and values therein) shall*106R-007 not cause message failure.
Example: The PVD facility segment is optional, but will be sent in a maximum
populated message type.
Use of a comprehensive, industry-accepted drug database [PR 2.2.3 and

106R-008]
A Status message with a code of 010 may not be responded to; it
shall*106R-072 be considered the final message (similar to the Verify).
See the Surescripts Implementation Guide as well as the Application
Certification Qualitative Requirements document for more
information and requirements.
37
NEWRX Application Certification Requirements

Prescriber Type NEWRX Requirements
Patients choice of pharmacy [106R-031]
For pharmacy search features:
The application shall*106R-032 allow a pharmacy search based on pharmacy type
(mail/retail).
When the user does not specify a pharmacy type, the application shall*106R 033 not
filter out mail order pharmacy types when a pharmacy search by geography is performed.
At a minimum, the application shall*106R-034 display the following pharmacy
information in the pharmacy search results: Pharmacy Name, Street Address, City, State,
Zip code, phone number, and pharmacy type (long term care, mail order, retail,
specialty).Summary Screen [ACR 106R-035 (includes 106R-036 to 106R-041)]
Pharmacy Type NEWRX Requirements

NEWRX Display [ACR 106R-044, 106-045]

information and requirements
38
Renewal Application Certification Requirements

Prescriber Type REFREQ Requirements [PR 5.2.6] - See guide for fields that shall*
be displayed, at a minimum [ACR 106R-059, PR 106R-060, PR 106R-061, 106R063]
The application shall*106R-048 support each Refill Renewal Response status type
(Approved, Approved with Changes, Denied, Denied-NewRx to Follow (DNTF). The
DNTF workflow is not for application limitations. Meaning, if the prescriber
application receives a Refill Renewal Request, the application shall*106R-049 not
create a DNTF because of internal workflow limitations (i.e., an optional field like
DaysSupply is not sent in the Refill Renewal Request and the application requires
it).
Pharmacy Type REFRES Requirements [PR 5.2.8] - See guide for fields that shall*
be displayed, at a minimum [ACR 106R-066, PR 106R-067]:
When sending a Refill Renewal Request, the pharmacy shall*106R-162 send the
Refill Renewal Request to the appropriate prescriber location when the prescriber
has more than one SPI in the Surescripts directories. Pharmacies need to use all
prescriber directory information provided to match at the appropriate location level.
Certification Qualitative Requirements document for more information and
requirements
39
Additional Prescription Routing Messages

CANRX
CANRES
CHGRX
CHGRES
Message
direction?
Prescriber to
Pharmacy
Pharmacy to
Prescriber
Pharmacy to
Prescriber
Prescriber to
Pharmacy
What is it used
for?
Used to cancel
a previously
communicated
prescription
(sent that
same day or
an existing
prescription)
Used to
indicate
success /
failure of
cancel request
Used to
request a
change to any
existing
refillable
prescription
(sent that
same day or
an existing
prescription)
Used to
indicate
approve /
denial of
change
request
Many of the same elements are shared between all NCPDP message types
EDIFACT and XML sample transactions [PR 9]

40
Pharmacy Types Only - Contracting

Cancel transaction is not included in master agreement
Change transaction is included in master agreement

Contact Surescripts to add an addendum for Cancel transaction or with
any questions
For existing clients, your Account Executive

41
Acknowledgement Messages
STATUS [PR 5.10] - Can only be synchronous (part of initial connection)
A Status message with a code of 010 may not be responded to; it shall*106R-072 be considered the final
message (similar to the Verify).
ERROR [PR 5.9] - Can be synchronous or asynchronous (part of

initial/new connection); Error codes and descriptions, when available,
give a more descriptive explanation of root cause
VERIFY [PR 5.8]

All Participants must accept Verify for certification
Can only be asynchronous (part of new, unsolicited connection)
Should not receive subsequent communications related to original message
EDIFACT and XML sample transactions [PR 9.10, PR 9.11, PR 9.12]


42
Controlled Substance Handling

43
Overview
Interim Final Rule (IFR) officially published as: The Electronic Prescriptions for
Controlled Substances, Final Rule; 21 CFR Parts 1300, 1304, 1306, and 1311;
Docket No. DEA-218; RIN 1117-AA61
For Prescription Routing v10.6, certifying on EPCS is optional; participants
must complete the following before being enabled on EPCS in production:
Surescripts Certification Performed with Surescripts Certification Team
Surescripts EPCS Representation and Warranty Provided to Surescripts, signed by
a member of Participants executive management affirming compliance with the
Interim Final Rule
Third-Party Audit (1311.300) - Performed with an approved auditor
The Interim Final Rule requires a re-audit every two years, or whenever aspects of their
application that are regulated change
At that time, an updated Third Party Audit and Surescripts Representation and Warranty will
need to be completed
Will Surescripts Certification cover Part 1311 Audit?

The Surescripts Certification is a technical certification to our network
This Certification does not qualify to meet the requirements outlined in the IFR for
auditing
44
v10.6 and EPCS

EPCS is a service level; it is not a transaction type
Surescripts has updated service and supporting documentation to meet
the DEA IFR for the electronic prescribing of controlled substances
(EPCS)
Gives prescribers the option of signing and transmitting prescriptions for
approved CS electronically
Fillable CS may flow electronically to another EPCS enabled Participant

Faxable error messaging is supported for non-CS, however, Surescripts will not
fax a CS message for any reason
Faxing gateway is still supported for non-CS; Surescripts will drop non-CS
prescriptions destined for a non-electronically enabled pharmacy to fax
(contracted service)
Faxback, where Surescripts faxes a CS back to a prescriber for signature, is no
longer offered (previously a contracted service)
See Faxing for more info [PR 3.11]
Participants must present proof of DEA IFR audit and complete

Surescripts Certification before transacting in production [PR 3.5]

45
EPCS Digital Signatures [1]

Message types checked [PR 3.5]; fillable messages
NEWRX > Medication Prescribed segment
REFRES > Medication Prescribed segment > Response status type is
Approved or ApprovedWithChanges
CHGRES > Response status type is Approved or ApprovedWithChanges
Either the digital signature block [PR 7] or the SI indicator is required on

EPCS messages
For digital signature block, Surescripts will only validate that the signature is
present and the transaction is in the valid format
Surescripts recommends Prescribing types do not use signature block or the SI
indicator on non-CS prescription messages as you risk the system rejecting a
script destined for a fax-only pharmacy or for a pharmacy on an older
Prescription Routing version
See guide for fields that must be digitally signed in the Medication
Prescribed segment [PR 7]
For those using PKI (Public Key Infrastructure) end-to-end solutions

these fields must be signed in order, including empty fields (i.e. notes)
and optional fields that are not provided, per the Surescripts
Implementation Guide

46
EPCS Processing [1]

CS II-V are permitted at a federal level; CS-I (i.e. heroin, LSD, PCP) and
prohibited State specific CS (i.e. NY does not permit EPCS of any CS)
are not permitted
Pharmacies may send a REFREQ/RXCHG for a CS regardless of whether the
prescriber is set up for the EPCS service or not
Surescripts recommends Prescribing types maintain their current workflow for
non-CS; instead check the pharmacys service level for EPCS before signing a
CS prescription message
Scripts identified as a CS (DEA Schedule value, NDC11) will be validated

against:
Participant EPCS service levels (sender and receiver)
Known Federal and State CS rules
State CS validation will take the origin (prescriber) and destination (retail pharmacy) of the
script in to consideration
State CS validation will not be applied to a mail order pharmacy type
Digital Signature or Digital Signature Indicator

DEA # in the prescriber segment must be associated with the SPI in the header
of the message or SSN in the prescriber segment must be associated with the
SPI for Public Health and Military prescribers allowed to prescribe (incompliance
with IFR)
DEA Schedule value check
47
EPCS Processing [2]

If CS validation passes Surescripts will:
Translate prescription between NCPDP SCRIPT versions and/or XML /
EDIFACT if necessary
Maintain digital signature block integrity if present
If digital signature is present, deliver to pharmacy for digital signature validation
by the pharmacy
If signature flag is present, Surescripts will sign and store the EPCS
transactions (the digital signature is not attached to the transaction), and deliver
the prescription to pharmacy
All Participants and end users (i.e. prescribers and pharmacists) are still
ultimately responsible for continued compliance with all Federal and State
regulations [PR 3.8.1]
Changes to Prescription Routing service for EPCS [ACR 11.6]
Includes recommended EPCS error codes and descriptions

48
State EPCS Rules

Check with the States you operate in for State specific CS regulations
Some states control medications that do not appear on the DEAs

schedules
Record retention periods may be longer in some states than the two
years the DEA requires (whichever is longest would govern)
Transfer of electronic prescriptions between pharmacies may be limited
by state rules
Prescribers and pharmacies are ultimately responsible for state level
prohibitions.
Surescripts will not accept from prescribers in states or deliver to retail
pharmacies in states that prohibit EPCS entirely, prohibit EPCS of CS-II, or
classify certain drugs as prohibited under EPCS
Surescripts will stop transactions recognized as non-compliant from being sent
or received

49
v10.6 without EPCS Service

Pharmacies may send a REFREQ/RXCHG for a CS regardless of whether the prescriber is set up
for the EPCS service or not
When the prescriber is NOT authorized to send EPCS messages:
CS NEWRX
Print off prescription, prescriber signs prescription, wet signature (When a prescriber
attempts to enter a prescription for a controlled substance and is NOT authorized to send
EPCS messages, the application shall*106R-169 direct the prescriber to a non-EDI workflow. )
Please reference local state rules and the DEAs Practitioners Manual section on Valid
Prescription
Requirements,
which
can
be
found
at:
http://www.deadiversion.usdoj.gov/pubs/manuals/pract/section5.html
CS II = Hand script to patient who will bring script to pharmacy

CS III V = See above or prescriber can fax script to pharmacy
CS REFREQ/RXCHG
For requests that the prescriber wishes to authorize:
The prescriber should send a REFRES with status type DNTF / CHGRES with the status
type of Denied and indicate in the response segments free text field that the response
will be followed by a new prescription order
Prescriber should then follow the same workflow as stated under CS NEWRX above or
call pharmacy
Regular denials should occur as stated in the requirements
50
10.6 EPCS continued

If the prescriber, who is NOT authorized to send EPCS messages, denies the Refill Renewal
Request for the controlled substance, the Refill Renewal Response shall*106R-170 be sent
electronically to the pharmacy with the appropriate denial information, just like denials for any
non-controlled Refill Renewal Request.
If the prescriber, who is NOT authorized to send EPCS messages, approves the Refill Renewal
Request for the controlled substance, the application shall*106R-171, on the back-end, send to the
pharmacy a Refill Renewal Response with a Denied New Prescription To Follow status along
with a note in the Denied Response segment (RES-040 or <DenialReason>) stating: Prescriber
system cannot transmit approved controlled e-prescription.
The application shall*106R-172 then direct the prescriber to a non-EDI workflow. On a printed
prescription there shall*106R-173 be an indication that this is in response to an electronic refill
renewal request for a controlled substance. The appropriate RxReferenceNumber from the
original Refill Renewal Request shall*106R-174 be included on the printed prescription.

51
Segment Overview

52
Message Requirements
Sender / Receiver must be properly registered within directories
Participant account / portal must be properly enabled
Schema validations
CS medication management
Acknowledgements and error handling process
Connectivity method is HTTPS posts over the Internet
IP Authentication
Restrictions are put in place limiting the source IP address
Messaging sourced from a non-authorized IP address will be rejected
Basic Authentication
Distinct user name and password is assigned to each portal
Inclusion of credentials (including proper encoding) is required for a message to validate
properly
Missing or inaccurate credentials will result in rejected messaging
Too many invalid attempts will result in lockout

Common Message Header: Example

<?xml version="1.0" encoding="UTF-8"?>
<Message xmlns="http://www.surescripts.com/messaging" xmlns:xsi="http://www.w3.org/2001/XMLSchema-instance" version="010"
release="006" xsi:schemaLocation="http://www.surescripts.com/messaging SS_SCRIPT_XML_10_6.xsd">
<Header>
<To Qualifier="P">1234563</To>
<From Qualifier="D">1234567890123</From>
Note new
format
<MessageID>2290</MessageID>
<RelatesToMessageID>777333</RelatesToMessageID>
<SentTime>2010-01-25T08:14:36</SentTime>
Sender Software
<SenderSoftware>
information is
<SenderSoftwareDeveloper>VendorName</SenderSoftwareDeveloper>
mandatory; data is sent
<SenderSoftwareProduct>XXX software</SenderSoftwareProduct>
to receiver
<SenderSoftwareVersionRelease>5.1</SenderSoftwareVersionRelease>
</SenderSoftware>
<RxReferenceNumber>73737373</RxReferenceNumber>
<PrescriberOrderNumber>PON123</PrescriberOrderNumber>
</Header>
<Body>
<EDIFACTMessage>NCPDP SCRIPT message goes here</EDIFACTMessage>
OR
Message contents in Surescripts XML format
</Body>
</Message>

PVD/Prescriber Segment
Segment supports prescriber and supervisor information
PVD-020 Reference Number / <Identification>
Up to three (3) IDs are permitted per the NCPDP SCRIPT Standard
For non-CS messages, only send one (1) or two (2) IDs as three (3) IDs may result in a
rejection when Surescripts must translate the message to an older Prescription Routing
version
NPI will be validated using the Luhn algorithm in both the Surescripts staging
and production environments
DEANumber or SSN and Military Public Health specialty code is mandatory on
EPCS messages
Per NCPDP recommendation, Drug Abuse Treatment ID should not be in the
prescriber segment; it should appear in the drug notes field [106R-102]
Be aware of your State specific requirements
See PVD Prescriber Segment [PR 6.8] for more information,

additional elements and the Application Certification Qualitative
Requirements document for more information and requirements

DRU/Drug Segment [1]

Segment supports medication requested, medication prescribed and
medication dispensed type information
DRU-010-03 Item Number / <DrugCoded.ProductCode>
When sending NDC, NDC must be an 11 digit NDC
In a NEWRX, the NDC should represent the drug name/strength/dosage form
DRU-010-17 DEA Schedule / <DEASchedule> = Use when drug item is a

CS
DRU-040 Date
Written Date = Required on all messages except for Change Request
Last Fill Date = Required in Medication Dispensed segments
Effective Date = New qualifier used on EPCS CS-II; for non CS-II messages, do
not populate the effective date as it may result in a rejection when Surescripts
must translate the message to an older Prescription Routing version
DRU-060-01 Refill Quantity Qualifier / <Qualifier>

Values = R, P, A, and PRN
PRN = Avoid use; removed from future NCPDP SCRIPT versions
See Refill Qualifier section for details on usage [PR 6.14.2]
DRU/Drug Segment [2]

DRU-090 Free Text / <Note>
EPCS section 1306.11 allows the prescriber to send an electronic prescription to
cover for his verbal order. When sending the electronic prescription this field
should be used to populate: Emergency Cover Prescription Do Not Fill
DRU-130 Do Not Fill/Profile Flag / <DoNotFill> - Used only in LTCPAC
For EPCS drug abuse treatment identifier [1306.05 (b)] and/or medical need
indication for GHB [1306.05 (c)] should appear here
DRU-110 Drug Coverage Status Code / <DrugCoverageStatusCode>

Sender must include either the NDC11 (DRU-010-03), compound indicator
(DRU-110) or supply indicator (DRU-110)
Receivers may not always see compound or supply information when message
is from a lower prescription message version
EPCS message may include the digital signature indicator; value SI (digital
signature indicator) may result in a rejection when Surescripts must translate
the message to an older Prescription Routing version, like v4.20
See DRU Drug Segment [PR 6.14] for more information, additional
elements as well as the Application Certification Qualitative
Requirements document for more information and requirements

57
RES/Response Segment
Response Segments in a REFRES:
Only certain fields may change or be added to a REFRES depending upon the
status type; guide covers this in detail in the RES segment
Changes or additions to medication information must be applied to both the
Medication Prescribed and Medication Dispensed segment in the REFRES
Status = Approved
Number of Refills = In a Refill Renewal Approved/Approved with Changes Response,
there shall*106R-050 be a non zero value sent for the refill quantity. Denied and DNTF
Refill renewal response shall*106R-051 have refill quantity 0.Status = Approved with
Changes
Prescriber Segment: Prescriber NPI, DEA or SSN and the Military Public Health
Specialty information, Prescriber Address (to match the address in the Surescripts
Directories), Prescriber Agent
Status = Denied
Number of Refills = 0 [ACR 106R-051]
Status = Denied New Prescription to Follow (DNTF)

See approved with changes status type. If any other fields change you shall* the DNTF
status type and workflow [ACR 106R-097]
See RES Response Segment [PR 6.6] for more information,

additional elements as well as the Application Certification
Qualitative Requirements document for more information and
requirements
58
COO/Coordination of Benefits Segment

Prescriber vendors who are utilizing or are in the process of certifying on
the Surescripts Prescription Benefits 270/271 transactions shall*106R068 populate the following in the NEWRX transaction with information
returned in a Surescripts 271 transaction:
In the Coordination of Benefits Segment (COO), populate the value contained in the related 271
transactions ISA13 field in to the NEWRX (see COO-010-01) and specify that the value is mutually defined
(see COO-010-02). For patients with more than one active coverage, the prescriber vendor shall*106R-148
only populate one COO loop where the segment shall*106R-149 contain the benefit information the
prescriber utilized to write the prescription.
Note: The XML tag relating to COO-010-02 is <MutuallyDefined>
In the Patient Segment, populate the patients PBM Unique Member ID (see PTT-050-02). For patients with
more than one active coverage, the prescriber vendor shall*106R-150, when available, only use the PBM
Unique Member ID associated with the coverage that is utilized to write the prescription.
Additionally, when the patient is eligible for pharmacy benefit:
Prescriber vendors shall*106R-147 populate, when available, the fields in the COO segment, along with
any data elements returned in the 271 that map to corresponding data fields in the COO segment. If the
PBM Unique Member ID is greater than 35 characters, then two loops of the PTT-050-02 shall be used
This segment is not permitted to be echoed in a refill response
See COO Coordination of Benefits Segment [PR 6.17] as well as the Application Certification
Qualitative Requirements document for additional application certification requirements

59
Additional Segments and Elements in v10.6

PVD Pharmacy Includes pharmacy demographic information
PTT Patient Includes patient demographic information
SIG Structured SIG Segment Meant to promote greater consistency
in specifying directions and build a way to do clinical review / analysis.
OBS Observation Segment Might be used to send patients height
and weight.
RxNorm Data RxNormcode can be translated directly to the various
Drug Compendia, so a prescriber using Compendia A can transmit an
RxNormcode and it will relate to the same exact drug in Compendia B for
the pharmacy. Will require updates from Drug Compendia or National
Library of Medicine.
See the Surescripts Implementation Guide as well as the
Application Certification Qualitative Requirements document for
more information and additional application certification
requirements

60
Miscellaneous
Translations for v10.6
See Translations for all translations [ACR 11.8]
Section covers how Prescription Routing v10.6 messages will be translated to
lower network level schemas, like v8.1e and v4.20
Possible actions: map, drop, reject
Refill Renewal Processing [ACR 11.8.5]
XML Nuances [PR Appendix A1.2]
Date/Time formats
Refer to schema for field definitions
Special character handling
Fields with a different implied length in XML
Empty tag handling
Drug Quantity = n..11 due to decimal point
See the Surescripts Implementation Guide for more information

61
Responsibilities and Timelines
Next Steps

62
Participant Responsibilities
Testing of inbound and outbound communications associated to Surescripts
Network
Development and thorough QA of software applications
Provide adequate resources to project; speed of implementation / certification is
heavily influenced by experience and amount of resources participating in the
project
Define internal support protocols as software becomes certified and is ready for
deployment into production environments

63
Surescripts Responsibilities
Maintain the staging environment
Provide assistance and support to those utilizing the Surescripts Implementation
Services
Provide a Surescripts Certification Project Manager during Certification
Additional Surescripts Network Benefits

Certification/re-certification
Fax backup service

Support services/tools, network management, and performance reporting
Visibility for your Product
Monthly Participant calls and bi-annual Participant workshops

Leadership in standards development and regulator/legislative affairs on eprescribing

64
Expectations
Average time spent in implementation and certification phase is 6-9 months
Several Participants have completed efforts in shorter time frames
Scope of project, resources available, other competing priorities, and expertise
on your team are just a few items that impact timeframes
Account for time spent to setup meetings, turn around issue/resolution/
adjustments, Certification Review Board, and Part 1311 audits
Post Certification Activities

Your certification notice triggers production readiness activities
Surescripts production teams will reach out to you for production readiness:
Alliances, Support, and Marketing
Operations begins process of creating production occurrences; allow for up to
two weeks to process your production setup

65
Implementation Recap
Implementation
Setup/upgrade staging account and portal settings
Review of Surescripts Implementation Guide changes for EPCS
Ongoing support during analysis, development, and testing
Analyze transmission and transaction detail, providing feedback as needed
Pre-certification assistance including a readiness review
Certification
Execute certification tests for all applicable transactions and scenarios
Transaction certification testing
Certify to Surescripts application certification requirements
Go-Live Preparations
Participants must complete and provide documentation on their Part 1311 audit
before they can be enabled for EPCS on the Surescripts network
Prepare setup/upgrade/migration/regression plan for production account and
portal settings
Go-Live
Send transaction on Directories v4.6 and Prescription Routing v10.6 in
production
66
TIPS: Self-Driven Implementation Participants

Pre-Certification Preparation
Clean Messages Do you have 10+ error free transactions for each directory
and prescription message type?
Varying Data Have you tested various pharmacies, prescribers, patients and
medications?
Documentation Does your application meet the guide, XSD validations, and
application certification requirements?
Contact Surescripts Certification Team
Thoroughly test your program as stated above
Instructions on how to contact certification will be provided along with your
Staging Connectivity information
Send email only when you are confident you will pass certification
Certification will schedule a meeting time with you
Self-Driven Implementation Participants who fail certification will be
directed to the Surescripts Implementation Team where hourly fees
apply

67
THANK YOU!

68

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Helpful Hints and Reminders Before We Begin

Copyright 2013 by Surescripts, LLC. All rights reserved.

NOTICE OF RECORDING AND FUTURE

ANY RECORDING OR USE BY ANY OTHER PERSON OR ENTITY FOR ANY

Prescription Routing v10.6, including EPCS

Copyright 2013 by Surescripts, LLC. All rights reserved.

Prescription Routing v10.6

Copyright 2013 by Surescripts, LLC. All rights reserved.

Copyright 2013 by Surescripts, LLC. All rights reserved.

Surescripts helps connect

Rhode Island Department

250+ Surescripts certified

The countrys largest

Copyright 2013 by Surescripts, LLC. All rights reserved.

Surescripts Core Services

Copyright 2013 by Surescripts, LLC. All rights reserved.

Todays Presentation [1]

Pharmacies and Pharmacy Technology Vendors (pharmacy types)

Participants who will certify on v10.6 without EPCS

Copyright 2013 by Surescripts, LLC. All rights reserved.

Todays Presentation [2]

This education series has been designed to highlight important

Variations specific to your account should be discussed with your

Use this presentation along with the implementation documentation

References back to the Surescripts Guides

[DIR x.x] = Surescripts Directories v4.6 Guide section

Copyright 2013 by Surescripts, LLC. All rights reserved.

Surescripts Professional Services

Basic Service Package

Copyright 2013 by Surescripts, LLC. All rights reserved.

Prescription Routing v10.6

Copyright 2013 by Surescripts, LLC. All rights reserved.

Refill Renewal Request and Response

Use of Federal Medication Terminologies (FMT)

Copyright 2013 by Surescripts, LLC. All rights reserved.

Required for Certification

Refill Renewal Request

Refill Renewal Response

EPCS is not a transaction type; it is a service level that is optional

Copyright 2013 by Surescripts, LLC. All rights reserved.

Setup in the Surescripts Staging

Copyright 2013 by Surescripts, LLC. All rights reserved.

Certificate Requirements include:

Surescripts Active/Active Data Centers

Surescripts URLs, IPs, and Ports

Copyright 2013 by Surescripts, LLC. All rights reserved.

Setup for Existing Participants [1]

All web service functions

Copyright 2013 by Surescripts, LLC. All rights reserved.

Setup for Existing Participants [2]

Copyright 2013 by Surescripts, LLC. All rights reserved.

Getting Setup in the Staging Environment

Participants who have elected for a self-driven implementation

To engage with Implementation Services:

Copyright 2013 by Surescripts, LLC. All rights reserved.

Copyright 2013 by Surescripts, LLC. All rights reserved.

Two ways to change directory entries:

During certification testing, the Participant must demonstrate:

Apply Surescripts Directory updates to your local system within 24 hours of

Changes for Directory 4.6

Changes for Directory 4.6, continued

Geocoded Addresses are now available for providers and

Copyright 2013 by Surescripts, LLC. All rights reserved.