The pharmacy workgroup of the California Clinical Data Project (CCDP) completed the CALINX Rx 2.0 Pharmacy Data Standard in 2005. The CALINX Rx 2.0 standard is based on the CALINX Pharmacy Data Standard Version 1.1, parts of which have been used by health plans and provider organizations in California in prior years. CALINX Rx 2.0 received consensus approval by the workgroup's 14 members and improves upon the previous version in several ways:
Six major health plans participating on the workgroup -- Aetna, Anthem Blue Cross, Blue Shield, Cigna, Health Net, and PacifiCare -- all agreed to implement the exact specifications of this version resulting in a single uniform data format where variations of the standard existed previously.
The health plans also agreed, in principle, to provide pharmacy data every 30 days at the request of provider organizations.
Several fields were added to facilitate the integration and correct interpretation of pharmacy claims data. These fields include a second patient identifier to aid in patient matching, and a separate prescription refill indicator to accommodate differences in health plans' reporting of these data.
The processes for error correction were clarified and standardized, allowing for the uniform handling of re-sent files and individual records, as well as claims reversals.
The documentation of the standard has been significantly improved to aid in the correct generation and interpretation of pharmacy claims files. Hyperlinked notes have been added to many field descriptions to clearly explain the purpose, meaning, and intended formatting of these fields. The implementation guidelines have been updated to better explain the correct formatting of various numeric data types and coded values.
Adoption of the new format requires minor changes to the software used by health plans and provider organizations that process CALINX v1.1 pharmacy data. However, CALINX Rx 2.0 will provide clearer and more consistent information regarding pharmacy utilization to provider organizations. Also, the uniform implementation of this standard will reduce the cost and complexity of integrating pharmacy information into data warehouses and disease registries, and the free software will expedite the processing of pharmacy utilization data encoded in the new format. Please refer to the CALINX Rx 2.0 Data Standard Toolkit and other resources (listed to the right) for details.
“To drive major improvements, performance-based payments must exceed 10% of total provider income. Incentives of this magnitude can only be mobilized if they originate in payer savings.”
