The Business Side: National e-Claims Standard (NeCST)

CPhA has led the development of electronic online pharmacy claims submission and adjudication standards for many years. Version 3 of the CPhA Pharmacy Claim Standard is used to adjudicate over 300 million prescriptions annually. In the late 1990s, CPhA worked with other stakeholders to revise version 3. This standard has now transitioned to become the National e-Claims Standard Initiative (NeCST).

The goal of the NeCST is to facilitate and support the development of a national electronic claims messaging standard for exchanging electronic health claims information across Canada, for private and public sector payors and for health service providers.

The NeCST initiative was begun in 2000 to develop a pan-Canadian electronic claims standard for private/public payors and providers in the following disciplines: Pharmacy, Chiropractic/Physiotherapy, Oral Health, Physician, Vision Care and Preferred Accommodation.

NeCST is comprised of a unique collaboration of public sector, private sector and provider associations. This collaborative effort represents thousands of participants and billions of dollars in health care spending. NeCST is being designed to facilitate health care claims transactions to authorize, compile, submit, adjudicate and pay health care invoices submitted by any provider to any payer in Canada that has implemented NeCST.

The architecture of NeCST is common on a financial level, with the ability to add clinical components (billable acts), as required to support invoicing. NeCST will provide a common platform for the submission of electronic claims for professional health services. The standard is based on HL7 version 3, an international messaging protocol.

NeCST was originally administered by the Canadian Institute for Health Information (CIHI) but is now being developed by Canada Health Infoway as part of their Standards Collaborative and their work towards an interoperable electronic health record. CPhA and the National Association of Pharmacy Regulatory Authorities (NAPRA) have jointly appointed representatives to sit on the Standards Collaborative Strategic Committee, the Standards Collaborative Coordinating Committee and the Standards Collaborative Coordinating Committee—Clinical Sub-Committee. These members will represent the interests of pharmacists throughout the standards development process.

For further information, please contact:
Janet Cooper
Senior Director, Professional Affairs
Tel: (613) 523-7877 or 1-800-917-9489
Fax: (613) 523-0445