Surescripts Certification Guide - 2013
Surescripts Certification Guide - 2013
Surescripts Certification Guide - 2013
Date: 2013
COPYRIGHT 2013 BY SURESCRIPTS, LLC. ALL RIGHTS RESERVED. PROPRIETARY AND CONFIDENTIAL. THIS DOCUMENT AND ALL
OTHER DOCUMENTS, MATERIALS, AND INFORMATION, TRANSMITTED OR ORALLY COMMUNICATED BY SURESCRIPTS IN THE COURSE OF
THE PARTIES DEALINGS CONSTITUTE AND ARE HEREBY DESIGNATED AS PROPRIETARY AND CONFIDENTIAL INFORMATION OF
SURESCRIPTS, AND MAY NOT BE REPRODUCED OR DISTRIBUTED (IN WHOLE OR IN PART) WITHOUT THE EXPRESS WRITTEN CONSENT OF
SURESCRIPTS
Information in this document is subject to change without notice. This document is the property of
Surescripts, LLC, and contains information that is proprietary and confidential. Surescripts is a registered
trademark of Surescripts, LLC. The Surescripts logo is a trademark of Surescripts, LLC. All other
trademarks are the property of their respective owners.
COPYRIGHT 2013 BY SURESCRIPTS, LLC. ALL RIGHTS RESERVED. PROPRIETARY AND CONFIDENTIAL. THIS DOCUMENT AND ALL
OTHER DOCUMENTS, MATERIALS, AND INFORMATION, TRANSMITTED OR ORALLY COMMUNICATED BY SURESCRIPTS IN THE COURSE OF
THE PARTIES DEALINGS CONSTITUTE AND ARE HEREBY DESIGNATED AS PROPRIETARY AND CONFIDENTIAL INFORMATION OF
SURESCRIPTS, AND MAY NOT BE REPRODUCED OR DISTRIBUTED (IN WHOLE OR IN PART) WITHOUT THE EXPRESS WRITTEN CONSENT OF
SURESCRIPTS
Table of Contents
1
INTRODUCTION ........................................................................................... 4
1.1
Document Purpose........................................................................................................................... 4
1.2
1.3
2.1
2.2
2.3
2.4
2.5
2.6
2.7
3.1
3.2
3.3
Recertification ................................................................................................................................ 15
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1 Introduction
1.1 Document Purpose
This Certification Guide has been created to provide Certification Participants with an overview of the
testing and certification processes associated with various core services offered by Surescripts.
Surescripts certification is a mandatory requirement for Participants wishing to connect to the Surescripts
network.
Important: Participants are required to execute the most updated version of this document as part of
advanced certification or other programs. Surescripts reserves the right to modify its certification process,
requirements and test cases as needed to ensure that software offerings can send and receive electronic
messages in accordance with the industry standards, safely and accurately. Surescripts shall notify
Participants of any such changes within an adequate timeframe to enable the Participant to comply with
any changes. All notifications shall be sent to the Participants designated point of contact.
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Scottsdale, AZ 85260-7518
Phone: (480) 477-1000
Fax: (480) 767-1042
http://www.ncpdp.org
XML
http://www.w3.org/XML/
ANSI
www.ansi.org
HL7
http://www.hl7.org/
Definition
Surescripts
Participant
Certification
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Establishing structure and processes around certification activities, including approval process
and recertifications.
Creating and maintaining certification test plans and test cases for all Surescripts services.
Playing a key role in determining certification requirements.
Developing processes, requirements and plans around new Surescripts offerings and industry
initiatives.
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Neutrality
Transparency
Auditability
Legality
When creating and updating the requirements, Surescripts receives input from our connected Participant
stakeholders across the industry and reviews all submitted certification requirement requests. We strive to
implement certification requirements that meet the needs of all Participant types, are consistent with our
Foundational and Guiding Principles, and drive e-prescribing process efficiency. We solicit feedback
from our Participants via Surescripts workshops and Participant surveys.
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Core Services
Surescripts' e-prescription services allow physicians to electronically send prescriptions from their
offices to any of 52,000 retail pharmacies and six of the largest mail-order pharmacies. In addition,
Surescripts provides physicians with electronic access to their patients prescription benefit and
prescription history, which helps to improve safety and enables doctors to prescribe medications at the
lowest cost to the patient.
Surescripts certifies software used by prescribers, pharmacies and payers/PBMs for access to three main
services:
Prescription Benefit
Prescription History
Prescription Routing
Medication History - Ambulatory: With a patient's permission, prescribers can use this
service to securely access aggregated prescription history data from community pharmacies, as
well as patient medication claims history from payers and pharmacy benefit managers.
2.7.1
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Surescripts Certification adds real value to an e-prescribing or electronic medical record (EMR)
product. E-prescribing is a key component of Meaningful Use as described in the Health Information
Technology for Economic and Clinical Health Act (HITECH). The following core Certification
Services are offered for Prescriber software:
Prescription Benefit and History
Eligibility/Formulary the ability to request and receive eligibility and formulary information
from payers and PBMs.
Prescription History (Ambulatory) the ability to request and receive prescription history
from Payers and PBMs.
Prescription Routing
New Prescriptions (retail pharmacy) the ability to route new prescriptions to community
pharmacies.
New Prescriptions (mail-order pharmacy) - the ability to route new prescriptions to mailorder pharmacies.
Prescription Renewals (retail pharmacy) the ability to electronically route prescription
renewal requests and responses with community pharmacies.
Prescription Renewals (mail-order pharmacy) the ability to electronically route
prescription renewal requests and responses with mail-order pharmacies.
Directories the ability to register and download provider information
The availability of this information, at the point of care, allows prescribers to determine the most
clinically appropriate and cost effective medication for the patient.
A Surescripts Solution Provider status is granted to Participants with products that have been certified
for all three Surescripts services (Prescription Benefit, Prescription History, Prescription Routing) and
supporting message types.
2.7.2
Surescripts Certification promotes a safer and more efficient prescribing process that leaves more time
for patient counseling and other revenue-producing opportunities.
Prescription Routing
Allows pharmacy software to receive new prescriptions, as well as send and receive prescription
renewal requests and authorizations.
New Prescriptions
Prescription Renewals
Directories
Benefits include improved patient safety, less time spent on paperwork and re-keying, and assurance of
cleaner scripts which require fewer callbacks for clarification.
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2.7.3
Surescripts Certification allows payers to assist prescribers in making more informed clinical decisions
and prescribing the most cost-effective medication.
Prescription Benefit
Allows payers and PBMs to respond to requests for eligibility and formulary from prescribers using
certified software.
Prescription History
Allows payers and PBMs to respond to requests for medication claims history from prescribers using
certified software.
Prescription Routing
Allows mail-order pharmacies to process new prescriptions and prescription renewals from prescribers
using certified software.
New Prescriptions
Prescription Renewals
Benefits include tighter formulary compliance, increased generic substitution rates, less therapeutic
duplication, enhanced data collection capabilities, greater control over routing of prescriptions, and direct
delivery of drug utilization review (DUR) messaging to prescribers.
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3 Certification Process
3.1 Certification Testing Process
All Participants need to execute a contract with Surescripts by going through the contracting process with
the Surescripts Legal Department before beginning the Certification Process. The Participant will be
provided an overview of Surescripts e-prescribing services in an education class and receive all
implementation/certification documentation, including certification test scenarios. The participant shall
also receive access to the Surescripts staging (testing) environment and various testing tools. The
Participant can choose to engage with Surescripts Implementation Services to receive assistance in
preparing for certification or select a self-driven implementation path. Information on how to contact
Certification team shall be provided during the education class.
The Surescripts Certification Process begins after the Participant has completed application development,
testing, and QA of its e-prescribing module. The Participant needs to successfully complete the
Surescripts Certification Process before moving into production. The Surescripts Certification Process
includes multiple steps as described below.
3.1.1
Detailed information about when and how to contact the Certification Team will be provided to the
Participant at the education class mentioned in Section 3.1. When a Participant is ready for certification
testing, it will be allotted a certification slot. Participants are scheduled for certification on a first come,
first served basis. A Surescripts Certification Project Manager will be assigned at the time of
scheduling. Each Participant shall work with a dedicated Surescripts Certification Project Manager
throughout the Certification Process.
The Surescripts Certification Project Manager shall provide an overview of the Certification Process
and the steps involved in certification testing for the Participant. The Certification Project Manager will
ensure that the Participant has received a copy of Surescripts certification testing scenarios and related
documentation. The Certification Project Manager will also work with the Participant to schedule
testing sessions.
3.1.2
Certification testing concentrates on message format and application workflow, including display. The
Surescripts Certification Team is primarily responsible for creating certification testing scenarios and
test cases. The test cases are created based on the Surescripts Implementation Guide(s) and Surescripts
Certification Requirements. The certification testing scenarios are shared with Participants in advance.
The Certification Team ensures that the test cases perform correctly by validating each test against
expected results in a controlled environment before finalizing and publishing the test cases.
The Certification Team periodically reviews the test cases and validates them against Surescripts
requirements for quality control and to ensure they produce correct results and are still relevant.
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3.2.1
Certification Requests
The Certification Project Manager presents the certification results to the Certification Review Board in
the form of a report containing the summary of tests conducted and results. The summary of
certification testing and request for certification will be sent via e-mail to all board members at least one
day before the Certification Review Board meeting.
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3.2.2
The Certification Review Board (CRB) will provide the final approval or denial, subject to appeals
rights (defined in another section) for all Participant certifications for all services on the Surescripts
Network.
The Certification Review Board consists of Surescripts functions that are closely associated to
Participant certifications and are responsible for maintaining the quality (including patient safety),
efficiency, and cost-effectiveness of the Surescripts Network. The Certification Review Board members
include the executives from the following Surescripts functions:
Quality
Certification Policy and Compliance
Implementation
Standards
Certification
Certification Review Board members provide final approval or denial to a Participants certification
based on results of certification testing conducted by the Certification Team.
The Certification Review Board will approve certification, deny certification, or request more
information for all certification requests presented during the meeting. The Certification Team
documents and records all Certification Review Board decisions and permanent records are maintained.
Each Certification Project Manager will communicate the Certification Review Boards decision to the
Participant whose certification results he/she presented to the Board. If certification has been denied,
the reason for denial will be clearly stated and communicated to the Participant.
3.2.3
All participants are required to abide by the Certification Review Boards (CRBs) decision. However,
we understand that in certain situations participants may desire to challenge the CRBs decision, and we
want to ensure that we provide the opportunity to do so. Therefore, should a participant wish to appeal
any CRB decision as it pertains to its certification, they are encouraged to do so pursuant to the
following guidelines:
After being notified by the Certification Project Manager indicating that its certification was denied, if a
participant wishes to challenge that decision they must submit a brief/documentation within 14 days
explaining why they believe their application should have been granted certification. Once this
documentation is received from the participant, the CRB shall review this document in the next
scheduled CRB meeting so long as the materials are received at least 4 days prior to that meeting. If the
CRB can make a decision based on the information provided, it will do so and communicate the
decision back to the participant. If the CRB determines that more information is required, the CRB will
set up a meeting with the participant as soon as reasonably possible, but no later than 30 days. At this
meeting, that participant can provide a demonstration of the application or explain why they believe the
application meets the certification requirements directly to the CRB so that a discussion of relevant
factors and concerns can take place in real-time instead of through email, and each side has the chance
to present its reasoning to the other. The CRB shall take this information and make its decision by the
next CRB meeting and communicate it to the participant.
Note: previously identified items remaining after follow up call are not eligible for appeal.
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3.2.4
Participants certifying for Surescripts Benefit and History Services need to complete an additional step
before receiving their final certification notice. After receiving Certification Approval by the
Certification Review Board, the Participant will need to demonstrate their application (Medication
History, Eligibility and Formulary functionality) to the representatives of some of the Pharmacy Benefit
Managers (PBMs).
3.2.5
After the Participant certification has been approved by the Certification Review Board and the PBM
joint demo has been completed (where applicable), the Certification Project Manager will send out the
final certification notice and the certificate. The certification notice and the certificate will list the
Certification Participants company name, application name and version number. The certification
notice and the certificate will be delivered to the Participant via e-mail.
3.2.6
After the final certification notice, the Participant will be listed on the Surescripts website as being
certified. The website will list Participants for all the services they have certified for. Use of the
Surescripts name and branded marks must follow use guidelines as outlined in the Surescripts Style
Guide, which is an integral part of the Participants contracting agreement with Surescripts.
3.2.7
Production Move
For Surescripts Network certifications, after the final certification e-mail, the Implementation Project
Manager will contact the certified Participant to initiate their move into the Surescripts production
environment. Note: This does not apply to Meaningful Use certifications.
The Participant is required to deploy their application as certified.
3.2.8
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3.3 Recertification
Surescripts grants certification specific to one application, one version, and one connection.
A recertification is required for changes affecting the e-prescribing interface including the connectivity
prior to moving it into production.
Participants must provide as much advance notice as possible (at least 4 weeks) to Surescripts of
application or infrastructure changes including, but not limited to, version releases. Once certified, please
work with your Account Manager for re-certification information and requests.
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4 Certification Compliance
The Certification Policy and Compliance Team works to validate that all connected Participants
implement and certify against a standard set of requirements. Once certified, the team monitors the
Participants to make sure all Participants remain in compliance with the standard set of requirements.
Should a participant be found non-compliant to any certification requirement(s) in production
Surescripts Compliance team may start a compliance review process and compliance plan. Failure to
meet with the compliance plan could result in the participants deactivation from the Surescripts network
and/or retraction of certified status. Surescripts goal is efficiency and consistency across the Network,
so all Participants can meet the highest measures of patient safety, end-to-end reliability, and electronic
prescription quality.
By adhering to the approved Surescripts Certification Requirements, Participants are assured they are in
compliance with transaction standards, Surescripts Network Requirements, and Surescripts Connectivity
Requirements. Adherence also enables Participants to send quality electronic prescriptions across the
Network.
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Directories Guide
Certification Requirements
Certification Guide
Admin Console User Guide
Description
The Implementation Guides are the
primary reference from which Network
Participants build e-prescription messages.
Guide distribution is dependent upon a
Participants particular implementation.
Reference guide from which Participants
build directories messages to add, update
and download prescriber and pharmacy
data. Certification requires compliance to
these guides.
These identify application level workflow
or items that are mandatory for transaction
on the Surescripts network. Certification
requires compliance to these requirements.
Test cases used by the Certification Team
for final certification testing of the
Participants application. Certification
requires compliance to these documents.
This document.
Guide which provides an overview of the
Admin Console which Participants and
Surescripts utilize to track messages.
Certification requires compliance to these
documents.
User guide for the testing tools available
via the Admin Console.
This template is used to capture issues
during the Certification testing phase and
may be presented to the Certification
Review Board (if warranted).
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