CPhA Pharmacy Claim Standard (CPhAPCS)
This CPhA Pharmacy Claim Standard (CPhAPCS) Standard was developed by the Canadian Pharmacists Association (CPhA) to provide orderly and efficient online processing of prescription drug claims. It is designed to serve the needs of pharmacists and drug benefit plan administrators to the benefit of their patients and clients. The CPhAPCS has evolved with the profession and industry and is used to adjudicate 475 million claims per year in Canada.
The objective of this standard is to provide a simplified and common claim format for all carriers to use. The goal is to provide real-time claims processing (data collection and payment) through a single device in the pharmacy which will link to all potential networks and carriers with which the community pharmacist may communicate, while avoiding double keying of information. In reaching this goal, the intent of the Standard is to support the needs of as wide a base of potential users as possible, while being flexible enough to change as needs and technology change and to provide simple and easy implementation.
Universal adoption of this Standard by providers and processors in Canada will enhance service efficiency in the pharmacy and improve the administrative functions of third party carriers.
The standard is maintained by CPhA and subscribers are sent the updated version of the standard twice a year.