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resQ

 

Get answers to your important questions about how resQ™ works and the data collected to make it the industry’s single source-of-truth for pharmacy credentialing information.

WHAT IS CREDENTIALING?

Healthcare organizations such as PBMs and health plans evaluate pharmacies with which they contract to confirm that they are adequately trained, certified and/or licensed and to confirm services they are able to provide.

The credentialing process provides the means for determining and validating a pharmacy’s credentials, ensuring that they are in good standing with applicable State and Federal laws, and meet quality performance standards.

resQ™ provides PBMs and payers with the information and documentation submitted by pharmacies in their NCPDP Pharmacy Profiles, to begin their validation and verification portion of the credentialing process.

WHAT INFORMATION IS INCLUDED IN resQ™?

resQ™ consists of all of the data included in dataQ® as well as an additional 250+ new data fields and documents that capture required CMS 42 CFR 455 regulatory information and credentialing data requested by PBMs and payers such as ownership details, insurance, sanctions and disciplinary information, immunizations offered, compounding and other licensing, certification and accreditations information and documentation.

ARE NON-PHARMACY DISPENSING SITES (NPDS)/PHYSICIAN OFFICES CREDENTIALS INCLUDED IN resQ™?

No. At this time NPDS sites are not able to complete and submit credentials. However, NPDS data and information that is currently found in dataQ® is still available in the resQ™ file.

DO I STILL NEED TO CONTINUE MY SUBSCRIPTION TO dataQ® IF I PURCHASE resQ™?

In most cases, you will only need to purchase resQ™. However, if you require the dataQ® data more frequently than credentialing data or dataQ® files will be separated and reside on another platform or used in other divisions of the organization that do not require the resQ™ credentialing information, then a separate dataQ® license may be required. Your NCPDP Account Executive will be help you determine if you need to also subscribe to dataQ®.

HOW MUCH DOES resQ™ COST?

Complete our Contact Us Form and will work with you to determine your specific solution needs and provide you with a quote.

WHAT FREQUENCY OF DELIVERY IS AVAILABLE TO resQ™ SUBSCRIBERS?

There are multiple deliverables available to our subscribers. NCPDP offers Monthly Full, Monthly transactional, Weekly Full, Weekly transactional.

DOES THE resQ™ FILE CONTAIN PERSONALLY IDENTIFIABLE INFORMATION?

resQ™ collects CMS required PII information. PII information is provided as part of the resQ™ only if Licensee a) is a Pharmacy Benefit Manager (PBM) or prescription drug plan payer, and b) is a CMS authorized Medicaid and/or Medicare provider subject to CMS 455 Disclosure regulations. Licensee must acknowledge that these requirements must be maintained in order to receive PII information.

Subscribing organizations take complete liability of SSN/DOB data upon receiving this data. The following terms and conditions are part of the required Contract for a resQ™ subscribing organization.

  1. "Personally Identifiable Information. The following provisions apply when Licensee has access to personal identifiers, including, but not limited to name, address, phone number, date of birth, Social Security number, other nonpublic personal information, financial account numbers, access codes, driver’s license numbers, and state- or federal-identification numbers such as passport, visa or state identity card numbers ("PII").
  2. Data Security. If Licensee stores PII received as part of this Agreement, Licensee warrants that the information will be stored and processed in accordance with applicable law and commercial best practices, including appropriate administrative, physical and technical safeguards to secure such information from unauthorized access, disclosure, alteration and use. Such measures will be no less protective than those used to secure Licensee’s own data of a similar type, and in no event less than reasonable in view of the type and nature of the data involved. Licensee will not use or store the Database(s) or any information obtained from via the Database(s) outside the United States without prior written consent from NCPDP.‚Äč
  3. "PII Requirements. Licensee hereby warrants and covenants to NCPDP that Licensee: a)is a Pharmacy Benefit Manager (PBM) or prescription drug plan payer, and b) is a CMS authorized Medicaid and/or Medicare provider subject to CMS 455 Disclosure regulations. Licensee acknowledges that these requirements must be maintained in order to receive PII information. Licensee must notify NCPDP of any changes in any of the above requirements immediately.
  4. File Delivery and Acceptance. Licensee must provide to NCPDP via the SFTP site, their public-key encryption. Within ten (10) business days after Licensee has confirmed NCPDP’s receipt of the public-key, NCPDP will provide the Database via the SFTP site. Licensee understands that it is responsible for download of the current Database files prior to the next delivery of Database files. NCPDP does not maintain nor can NCPDP provide archive files.
  5. Indemnity. Licensee shall indemnify and hold harmless NCPDP and its trustees, officers, employees, agents, and subcontractors from and against all claims, costs, losses, or damages (including attorneys’ fee) arising from any breach of this section, and for Licensee’s violation of any other applicable laws and regulations related to such information.”

WHAT REQUIRED DOCUMENT COPIES ARE AVAILABLE IN resQ™ AND HOW DO I ACCESS THEM?

Documentation is accessed using the WebConnect Plus add-on license or the Document Batch Download. Your resQ™ subscription includes one (1) Webconnect Plus license as well as the Document Batch Download Functionality.  Webconnect Plus allows the user to access and download a single pharmacy's information.  The Document Batch Download feature allowssubscribers the ability to download up to 50 pharmacies' documentation via zip file at a time.   Additional WebConnect Plus licenses can be purchased on a per user basis. Each user license costs $1,000 per year. Here is a check list of documentation required by credentialed Pharmacies in resQ™.

IS THE DATA AND INFORMATION IN  resQ™ VERIFIED BY PRIMARY SOURCES?

No. resQ™ contains self-reported data from the pharmacies and is not verified by primary source.

WHAT CMS REGULATIONS/DEFINITIONS ARE THE OWNERSHIP QUESTIONS IN THE PROFILE BASED UPON?

We base our Ownership questions on the following CMS regulations.

§455.101 Definitions.
 

Ownership interest means the possession of equity in the capital, the stock, or the profits of the disclosing entity.

Person with an ownership or control interest a person or corporation that -

  1. Has an ownership interest totaling 5 percent or more in a disclosing entity;
  2. Has an indirect ownership interest equal to 5 percent or more in a disclosing entity;
  3. Has a combination of direct and indirect ownership interests equal to 5 percent or more in a disclosing entity;
  4. Owns an interest of 5 percent or more in any mortgage, deed of trust, note, or other obligation secured by the disclosing entity if that interest equals at least 5 percent of the value of the property or assets of the disclosing entity;
  5. Is an officer or director of a disclosing entity that is organized as a corporation; or
  6. Is a partner in a disclosing entity that is organized as a partnership?

Indirect ownership interest means an ownership interest in an entity that has an ownership interest in the disclosing entity. This term includes an ownership interest in any entity that has an indirect ownership interest in the disclosing entity.

§455.102 Determination of ownership or control percentages.

  1. Indirect ownership interest. The amount of indirect ownership interest is determined by multiplying the percentages of ownership in each entity. For example, if A owns 10 percent of the stock in a corporation which owns 80 percent of the stock of the disclosing entity, A's interest equates to an 8 percent indirect ownership interest in the disclosing entity and must be reported. Conversely, if B owns 80 percent of the stock of a corporation which owns 5 percent of the stock of the disclosing entity, B's interest equates to a 4 percent indirect ownership interest in the disclosing entity and need not be reported.>
  2. Person with an ownership or control interest. In order to determine percentage of ownership, mortgage, deed of trust, note, or other obligation, the percentage of interest owned in the obligation is multiplied by the percentage of the disclosing entity's assets used to secure the obligation. For example, if A owns 10 percent of a note secured by 60 percent of the provider's assets, A's interest in the provider's assets equates to 6 percent and must be reported. Conversely, if B owns 40 percent of a note secured by 10 percent of the provider's assets, B's interest in the provider's assets equates to 4 percent and need not be reported.

Summarized:

Ownership interest means the possession of equity in the capital, the stock, or the profits of the disclosing entity.

Person with an ownership or control interest means a person or corporation that -

  1. Has an ownership interest totaling 5 percent or more in a disclosing entity;
  2. Has an indirect ownership interest equal to 5 percent or more in a disclosing entity;
  3. Has a combination of direct and indirect ownership interests equal to 5 percent or more in a disclosing entity;
  4. Owns an interest of 5 percent or more in any mortgage, deed of trust, note, or other obligation secured by the disclosing entity if that interest equals at least 5 percent of the value of the property or assets of the disclosing entity;
  5. Is an officer or director of a disclosing entity that is organized as a corporation; or

Indirect ownership interest means an ownership interest in an entity that has an ownership interest in the disclosing entity. This term includes an ownership interest in any entity that has an indirect ownership interest in the disclosing entity.