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 11, 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 11, 2027 through February 11, 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 February 11, 2028, the standard identified in paragraph (b) of this section.