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.

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Contact:

service@pharmacists.ca
1-800-917-9489 or 613-523-7877 

Submitting a Change to the PCS

To request changes or updates to the CPhA Pharmacy Claim Standard (CPhAPCS), please complete and submit our Change Request Form. All requests will be reviewed and assessed based on the nature and scope of the change.

Change Request Process:

• The time required to document and publish the change will vary depending on the type of request submitted. Requestors will receive a preliminary response within 10 working days of the initial request. This response may include further timelines based on the complexity of the request. Please note that some requests may need to be reviewed by the PCS Steering Committee, while more significant updates may be incorporated into the new FHIR version of the PCS.
• Disclaimer: The implementation of approved changes by pharmacy software vendors and adjudicators will vary, as each organization has its own update schedules and processes.