US · guidance
CMS Pub. 100-18, ch. 14, § 50.4.1
Receiving an Nx Transaction, Without Supplemental Payer on File
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Part D sponsors should accept Nx transactions even in those instances where they have no
supplemental payer information on file to identify the payer. In instances when the Part D
Sponsor does not have matching or any supplemental payer information on file, the Nx
transactions should be applied to the member’s TrOOP as non-qualified and not TrOOP
eligible unless the payer is on the CMS SPAP/ADAP list. CMS encourages sponsors to
subsequently follow up by contacting the beneficiary to identify the supplemental payer.
Once the sponsor receives this information, except for SPAP/ADAP coverage, it should be
transmitted to the BCRC for verification of the secondary coverage.
Note that when receiving an Nx transaction without supplemental payer on file the
requirement to process claims in real time to support the TrOOP facilitation process applies
regardless of the primary or secondary (MSP) nature of the Medicare Part D claim.
The application of an Nx Transaction, without Supplemental Payer on file, is expected to be
reflected appropriately in all down-stream reporting, including, but not limited to
Prescription Drug Event (PDE) and Explanation of Benefits (EOBs).
History
(Rev. 17, Issued: 08 -23-13, Effective Date: 06-07-10, Imple mentation Date : 01-01-11)
Provenance
- Source
- cms.gov
- Retrieved
- 2026-09-17
- Edition
- iom-2026-09-17
- Content hash
e57888f3b26982bc5d6f8a6ff711a6f2cf0ff52d9383702d546c623f23f92d6b
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