WIXLIB

Implementation ProcessFormat RequirementThe submitter will submit data in ASAP 4.2 format. For details consult the Implementation Guidefor Prescription Monitoring Programs Version 4 Release 2 tml).The requirements for the state of Nebraska are detailed in ASAP 4.2 Specifications for Reportingthe Data.Connection MethodsThe submitter will connect via one of the following methods. A user account has to be set upbefore using any of the methods.ProtocolSecure FTP (SFTP)Web EntryMessage Format SupportedASAP 4.2 Character DelimitedManual EntryData Submitter Upload Account SetupDispensers will need to complete the online dispenser uploader user access request form(available on https://www.surveymonkey.com/r/uploader 2019) to setup their uploader account.The data submitter will provide information specific to the dispenser to enable access to thefacility-specific SFTP site or to the manual web entry portal. Once setup, DrFirst will provide therequestor a link via email which will allow the requestor to create their username and password.Upon completion of the setup of the username and password, DrFirst will provide the requiredSFTP site information.Guidelines for PDMP Reporting in NebraskaReporting PartiesPrescriptions dispensed in Nebraska or distributed to an address in Nebraska must be reportedby the dispenser or their designee which include: Community PharmaciesMail Service PharmaciesDelegated DispensersOther providers dispensing prescriptions as indicated aboveVersion 3.8 11

Data Required to be ReportedDispensers must collect and submit information about all dispensing of monitored prescriptiondrugs. Supplies and Durable Medical Equipment (e.g., diabetic test strips, syringes, crutches, IVpumps) are not required to be reported. The timing of prescription data submission from thelegislation is below:DateReported Data01/01/2017All Schedule II, III, IV and V dispensed prescriptions of controlledsubstances01/01/2018All dispensed prescription drug informationFrequency of Data ReportingNebraska law requires all prescriptions dispensed in this state or to an address in this state to beentered into the system by the dispenser or his or her designee daily after such prescription isdispensed.Dispensing Event ExemptionsThe following events are exempt from being reported to the Nebraska PDMP: The delivery of a prescription drug for immediate use for purposes of inpatient hospitalcare or emergency department careThe administration of a prescription drug by an authorized person upon the lawful order ofa prescriberA wholesale distributor of a prescription drug monitored by the prescription drugmonitoring systemThe dispenser does not dispense controlled substance prescriptions. (Valid in 2017 only)ExemptionsIf a pharmacy meets one of the exemptions as identified according to Neb. Rev. Stat. § 71-2454(6)(b), you may complete the online Exemption Information Form located athttps://www.surveymonkey.com/r/Exemption Form.Guidelines for Zero Reporting If a Dispenser has no dispensing transactions to report for the day, the dispenser must submita zero report, as described in the Specifications for Zero Reporting section in this guide.If a Dispenser reporting via web entry has no dispensing transactions to report for the day, noaction is necessary.If an exemption to reporting is needed by the Dispenser, refer to the Exemptions sectionabove.Version 3.8 12

Data Submission RequirementsAll submitters are responsible for checking the status of their data submissions. It is expected thatthe data is validated prior to submission to meet the Nebraska PDMP requirements as stated inthis guide. All prescriptions with errors will not be uploaded into the system. An error report willbe provided. Once the data is corrected, the submitter should resubmit the data as soon asreasonably possible.SecurityIn order to maintain the highest level of data security possible, DrFirst implements variousAdministrative, Technical, and Physical Safeguards. DrFirst Data Centers are SOC 2 certified to ensure physical and logical security, systemavailability and protection of all Patient Health Information (PHI).DrFirst is a SAS-70 certified organization, indicating third-party validation of the controlsand safeguards that have been put in place to host and process PHI related data.All staff members are trained, by a qualified independent vendor, on HIPAA privacy andsecurity. Staff members whose roles require routine access to PHI receive quarterlyrefresher HIPAA training. Access to PHI is restricted by a need-for-role policy to prescreened personnel.For more in-depth information, the DrFirst IT Security Brief is available upon request.File SpecificationsFile StructureUploaded reporting must be provided by dispensers in the ASAP 4.2 delimited format (via SFTP).The (Required) column in the field specification indicates whether the data element is mandatoryor not mandatory.Data Type Notation MatrixData Type NotationData TypeCharacter Set / FormatANAlphanumeric DT8DateUpper and lower-case alphabetso A to Z, a to zNumberso 0 to 9Printable characterso !@# % &*()- {}[]\ ';:" ,.?/Format: CCYYMMDD Version 3.8CC represents centuryYY represents yearMM represents monthDD represents Day 13

TM6TimeFormat: HHMMSS or HHMM in 24 hours clocksystem (military format) HH represents hourMM represents minutesSS represents secondsNNumericUsed for a whole number, decimal must not beused.DDecimalUsed for metric decimal. When the data is awhole number, decimal must not be used.Data Delimiters and Terminators Segment Identifier – indicates the beginning of a new segment, for example PHA.Data Delimiter – character used to separate segments and the data elements within asegment, for example, an asterisk (*). Each completed field must be followed by anasterisk, and each blank field should contain a single asterisk. If the last field in thesegment is blank, it should contain an asterisk (*) and a tilde ( ).Segment Terminator – character used to mark the end of a segment, for example, thetilde ( ).Note: Field TH09 in the Transaction Header segment contains a built-in segment terminator.Since TH09 also signifies the end of the segment, it must contain two tildes ( ).CodeDescriptionYMandatory. Data must be provided in the field.NNot mandatory (even if not mandatory, all fields are desired).File Naming ConventionFieldSizeRequiredDescriptionFile NameAN120YName assigned to the file by uploaderCharacter limit of 120 includes the extensionRecommended: ExtensionVersion 3.8YCreate a unique file name for each file as tonot create duplicate filesAcceptable special characters: underscoreand hyphenAcceptable extensions:.dat.txt 14

File Transfer/Load Timing The Dispenser will post on the DrFirst SFTP site daily. Multiple file uploads should beuploaded in the order in which they need to be processed.Processing Order In the event that multiple files are present, the files will be processed starting with the topmost file in the SFTP folder.ASAP 4.2 Specifications for Reporting the DataThe information on the following pages contain the definitions for the specific contents requiredof uploading records (reporting) in the American Society for Automation in Pharmacy (ASAP) 4.2format to comply with the Nebraska PDMP requirements.TH – Transaction Header – RequiredTo indicate the start of a transaction. It also assigns the segment terminator, data elementseparator, and control number.FieldField NameSizeRequired DescriptionTH01Version/ReleaseNumberAN4YCode uniquely identifying thetransactionValue: 4.2TH02TransactionControl NumberAN40YSender assigned code uniquelyidentifying a transactionGUID is recommendedTH03Transaction TypeN2YIdentifies the purpose of initiatingthe transactionValue: 01 Send/RequestTransactionTH04Response IDAN40NTransaction Control Number of atransaction that initiated thetransaction Required in responsetransactionTH05Creation DateDT8YDate the transaction was createdFormat: CCYYMMDDTH06Creation TimeTM6YTime the transaction was created.Format: HHMMSS or HHMMVersion 3.8 15

TH07File TypeAN1YCode specifying the type oftransactionValue: P ProductionT TestProper codes should only be sentin their respected environmentsTH08Routing NumberN6NNot UsedTH09SegmentTerminatorCharacterAN1YThis terminates the TH segmentand sets the actual value of thedata segment terminator for theentire transactionIS – Information Source – RequiredTo convey the name and identification numbers of the entity supplying the information.FieldField NameSizeRequired DescriptionIS01UniqueInformationSource IDAN10YReference number or identificationnumberFor example: Populate with unique informationsource ID, assigned by DrFirstand obtained when registered asan uploader-OR IS02IS03InformationSource EntityNameMessageVersion 3.8AN60YPhone Number, if used topopulate this field do not includehyphens or parenthesesEntity name of the Information SourceFor example: AN60NPopulate with unique informationsource entity name, assigned byDrFirst and obtained whenregistered as an uploaderFreeform text message 16

PHA – Pharmacy Header – RequiredTo identify the Dispenser. Maximum 999 in a Batch.FieldField NamePHA01 National ProviderIdentifier (NPI)SizeRequired DescriptionAN10YMust be populated with the OrganizationNPI.If the pharmacy does not have a NPI, it isrecommended to populate PHA01 withthe pharmacy phone numberPHA02 NCPDP/NABPProvider IDAN7NIdentifier assigned to pharmacy by theNational Council for Prescription DrugPrograms.Populate when available.PHA03 DEA NumberAN9NPopulate when available.PHA04 Pharmacy orDispensingPrescriber NameAN60YName of the Pharmacy or DispensingPrescriber.PHA05AddressInformation – 1AN30YAddress Line 1 of the Dispenser Location.PHA06 AddressInformation - 2AN30NAddress Line 2 of the Dispenser Location.PHA07 City AddressAN25YCity of the Dispenser Location.PHA08 State AddressAN2YValid State Code – US Postal Servicestate code, Canada or Territories.PHA09 Zip CodeAN9YUS Postal Zip Code of the DispenserLocation.PHA10 Phone NumberAN10NComplete Phone number including AreaCode.PHA11 Contact nameAN30NContact person name.PHA12 Chain Site IDAN10NStore number assigned by the chain tothe pharmacy location.PAT – Patient Information – RequiredUsed to report the patient’s name and basic information. Max 25,000 in a batch.FieldField NameSizeRequired DescriptionPAT01ID Qualifier ofPatient IdentifierAN2NVersion 3.8Code identifying the jurisdiction thatissues the ID in PAT03. 17

See Appendix A for list of jurisdictions.PAT02ID QualifierN2YCode to identify the type of ID in PAT03.If PAT02 is used, PAT03 is required.Value: 01 Military ID02 State Issued ID03 Unique System ID04 Permanent Resident Card(Green Card)05 Passport ID06 Driver’s License ID07 Social Security Number08 Tribal ID99 Other (Trading partner agreedupon ID, such as cardholder ID)PAT03ID of PatientAN20YIdentification number for the patient asindicated in PAT02. It is recommended topopulate PAT03 with a patient identifiersuch as driver’s license or governmentissued identifier, but the system willaccept a pharmacy software-generatedunique patient identifier.PAT04ID Qualifier ofAdditionalPatient IdentifierAN2NCode identifying the jurisdiction thatissues the ID in PAT06.AdditionalPatient IDQualifierN2PAT05See Appendix A for list for jurisdictions.NCode to identify the type of ID in PAT06.If PAT05 is used, PAT06 is required.Value: 01 Military ID02 State Issued ID03 Unique System ID04 Permanent Resident Card(Green Card)05 Passport ID06 Driver’s License ID07 Social Security Number08

ASAP 4.2 standard. 6/7/2016 DrFirst and NeHII 1.1 Appendix A Added Appendix A to clarify jurisdiction code for PAT01 6/7/2016 DrFirst and NeHII 2.0 ASAP 4.2 Specifications for Reporting the Data Corrected field size information to align with ASAP 4.2 standard (TH07,TH08, PAT21, DISP16) 8/31/2016 DrFirst and NeHII 2.0 Exemptions