As of today, NCPDP drives the standard for the interface used to communicate with the switch. Any upgrades to the interface require changes to all systems communicating with the switch. This created a need for a solution that ensures the changes in the interface do not result in a need for major development changes in individual systems.

The Recast Claims Formatter API contains two APIs, Telecom Formatter (formats the claim) and Formatter Rule Engine (applies current claim format standards), that work together to format your insurance plan claims for submission.

The Telecom Formatter accepts pharmacy transactional data that is formatted to the appropriate NCPDP Telecommunication standard and submitted to the defined intermediary on your behalf, based on your defined standard version. The Pharmacy Management System sends the data in a JSON structure to the Telecom Formatter and ensures the output is formatted per NCPDP standard.

The Formatter Rule Engine is the technical implementation of Payor Sheets. Payor Sheets are provided by the insurance providers, defining what is Mandatory/Situational/Not Required for fields within the NCPDP string.

The Formatting Rule Engine enables you to define Mandatory/Situational/Not Required fields, including the default value for fields, data type, size, and conditions for certain fields.

How it works

1. Pharmacy Management System sends the Format Request (formatDetails) to the Telecom Formatter API.
2. The Telecom Formatter sends the (fetch) Request to the Formatter Rule Engine for the data received from the Pharmacy Management System.
3. The Formatter Rule Engine responds with the Format claim details.
4. Telecom Formatter uses the format details from Formatter Rule Engine and formats the claim and responds to the Pharmacy Management System with the formatted claim.
5. Pharmacy Management System then uses the formatted claim and sends the request to the switch in the expected format.
6. Switch responds to the Pharmacy Management System in the NCPDP formatted string.
7. Pharmacy Management System then forwards the string to telecom formatter.
8. Telecom Formatter converts the NCPDP standard response string to JSON back to the Pharmacy Management System.

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API Access

You must have sandbox/production credentials (client_id and client_secret) to access these URLs.

To view additional API access information, view the Getting Started page.

Select the Learn more button to visit the AI marketplace.

URLs

https://sandbox-apigw.optum.com/rxn/telecomformatter/v1
https://sandbox-apigw.optum.com/rxn/formattingrules/v1

https://apigw.optum.com/rxn/telecomformatter/v1
https://apigw.optum.com/rxn/formattingrules/v1