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MedicaidAdministrativeMedium impact

National Council on Prescription Drug Programs (NCPDP) Billing Changes

Illinois Medicaid - HFS·IL · Pharmacy·Provider Notice
Effective date
Not stated
We identified it
Jun 21, 2026
Days to comply
—

Summary

NCPDP billing format is changing from Version 3A to Version 5.1 for pharmacy claims. The key difference is that Version 5.1 requires exact quantities dispensed (including decimals) while Version 3A required rounding up quantities.

Action Required

Action needed
Immediately: Contact software vendors to upgrade to NCPDP Version 5.1 format as soon as possible. Ensure billing system captures exact quantities dispensed (no rounding up). Verify software captures, retains and displays Authorization Numbers from the department for problem billing inquiries. Note that Version 3A will be discontinued on a future date to be announced.

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