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| Subpart S | Medicaid Pharmacy Subrogation | 162.1901 – 162.1902 | ||||||
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42 U.S.C. 1320d—1320d-9 and secs. 1104 and 10109 of Pub. L. 111-148, 124 Stat. 146-154 and 915-917.
65 FR 50367, Aug. 17, 2000, unless otherwise noted.
74 FR 3328, Jan. 16, 2009, unless otherwise noted.
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74 FR 3328, Jan. 16, 2009, unless otherwise noted.
The Medicaid pharmacy subrogation transaction is the transmission of a claim from a Medicaid agency to a payer for the purpose of seeking reimbursement from the responsible health plan for a pharmacy claim the State has paid on behalf of a Medicaid recipient.
The Secretary adopts the following standards for the Medicaid pharmacy subrogation transaction:
(a) For the period from January 1, 2012 through August 14, 2027—The NCPDP Batch Standard Medicaid Subrogation Implementation Guide, Version 3.0, July 2007 (incorporated by reference at § 162.920).
(b) For the period from August 14, 2027 through April 14, 2028—
(1) The standards identified in paragraph (a) of this section; and
(2) The NCPDP Subrogation Implementation Guide for Batch Standard, Version 10, September 2019 (incorporated by reference at § 162.920).
(c) For the period on and after April 14, 2028, the standard identified in paragraph (b) of this section.
[89 FR 100789, Dec. 13, 2024, as amended at 90 FR 40749, Aug. 21, 2025]