hipaa x12 version 5010 and ncpdp version d.0 frequently ... - eMedNY

HIPAA X12 VERSION 5010AND NCPDP VERSION D.0FREQUENTLY ASKED QUESTIONSVersion 5010 is the new version of the X12 standards for HIPAA transactions and replaces Version4010/4010A1. Version D.0 is the new version of the National Council for Prescription DrugPrograms (NCPDP) standards for pharmacy transactions and replaces Version 5.1. New YorkMedicaid is preparing its system to accept and process both Versions 5010 and D.0 in accordancewith federal timelines. Below is an initial list of FAQs that should be very useful to our provider andvendor communities. The list will be revised regularly as we proceed with our design, developmentand implementation initiatives.QUESTIONANSWERGeneral Section1. What is the compliance date for Version5010 and Version D.0?The federal mandatory compliance date isJanuary 1, 20122. How much time will I have to test andtransition to Version 5010 for X12 andNCPDP (D.0)?3. How will I be able to submit a test?4. Where do I find the Implementation Guidesfor the 5010 and NCPDP (D.0)?5. Will ICD-10 be implemented at the sametime with 5010 and D.0?6. I submit my claims through a billing service,what changes will I need to make?Test and transition time frames have not beendetermined yet. Stay tuned for future updates.Users of the eMedNY Provider TestingEnvironment will use their existing FTP oreXchange mailboxes and User-ID accounts fortesting.For this reason it is critical that the “TestIndicator” in ISA15 is set to “T”. Otherwisetest transactions will be processed throughthe production environment.The 5010 Implementation Guides are availablefor purchase from the X12 Store at their website,http://store.x12.org/. The NCPDPImplementation Guides are available fromNCPDP at www.NCPDP.org.No. ICD-10 will be implemented subsequent to5010 and D.0.Contact your billing service and confirm that allchanges associated with Version 5010 will becommunicated in a timely manner.NY MEDICAID 5010 D.0 FAQ PAGE 1 August 2010

Pharmacy Only SectionThe Supplemental Remittance will contain onlyPENDED claimsMMIS Edits will only be available in theSupplemental for PENDED claimsClaims that fail history claim edits, such asduplicates will contain the TCN of conflictingclaim (only for 5010 version).17. Will the Pharmacy form (eMedNY 00301)be changing?18. Will the NCPDP claim transaction havechanges related to reporting the NDC?19. How will ingredients be processed?Pharmacy forms will accommodate the 12-position Rx #.Yes, eMedNY will conform to the NCPDPstandard for compound claims.All ingredients will be priced individually butcombined for the claim total.Non Pharmacy Section20. What kind of changes do I have to make onNone.my 4010 837 transactions?21. Will paper forms be changing? No.22. Are there changes to how the Group ID is Yes, the Group Provider ID can only be sent inentered?2010AA NM109 in the 5010.Yes. In the 4010 0FILL was entered in Loop2000B SBR04 = 0FILL .In the 5010 0FILL is derived by the system. In23. Are there changes to how I enter 0FILL? Loop 2320, if the AMT02 (Coordination ofBenefits (COB) Total Non-Covered Amount) isgreater than zero, Submitters should not submit0FILL AMT02 (above) for claims that havebeen adjudicated by the payer identified in 2320.24. Will the 837P use Condition Codes? Yes, please see the CG, when posted.NY MEDICAID 5010 D.0 FAQ PAGE 3 August 2010