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HIPAA: 4010/NCPDP 5.1 & 1.1
4010 Shutdown Successfully Implemented
All ASC X12N 837 v.4010A1 transactions submitted on or after 5 p.m. on April 30, 2013, will be deleted with CMC error codes 58: Media type/claim type not valid for this submitter and 55: Submitter/claim type not approved for included attachment.
Any 4010/4010A1 or NCPDP 5.1/1.1 transactions submitted after this date will be rejected and result in non-payment of claims.
Submitters who have not certified or converted to ASC X12N 5010 and NCPDP D.0/1.2 formats can contact the Computer Media Claims (CMC) Help Desk to schedule testing by calling the Telephone Service Center (TSC) at 1-800-541-5555 and selecting option 4 then option 2.
Additional information can be located on the HIPAA/5010/4010/NCPDP page located under the References tab of the Medi-Cal website.
Mailing Address Verification for ASC X12N 4010A1 and NCPDP 5.1/1.1 Submitters
If a submitter sending Computer Media Claims (CMC) transactions in either the ASC X12N 4010A1 or NCPDP 5.1/1.1 formats has not yet received a letter announcing the new December 31, 2012 end-date for accepting these formats, Medi-Cal may not have their current mailing address. Submitters who have not received this letter should contact the CMC Helpdesk to update their mailing address. Submitters can reach the CMC Helpdesk by calling the Telephone Service Center (TSC) at 1-800-541-5555, select option 4 for the Technical Help Desk, followed by option 2 for CMC. Submitters must convert to the current 5010 formats before December 31, 2012, to be able to continue to submit claims and other transactions electronically.
HIPAA 4010 Companion Guides no Longer Available
The ASC X12N Version 4010A1 Companion Guides are no longer available on the Medi-Cal website.
Providers who submit claims using HIPAA 4010A1 standards and who have questions concerning the information previously contained in these guides can call the Computer Media Claims (CMC) Help Desk at 1-800-541-5555, option 4 for the Technical Help Desk, followed by option 2 for CMC.
HIPAA 4010A1 Submission Instructions Removed from Provider Manual
Originally Published June 16, 2012
Update: December 31, 2012, has now been announced as the last day that the 4010A1 and NCPDP 5.1/1.1 formats will be accepted.
Beginning June 25, 2012, the new HIPAA 5010 transaction standards will be implemented. However, providers who choose not to transition to submit 5010 transactions may continue to submit claims using the 4010A1 standards, as they will continue to be accepted after June 25, 2012. The Medi-Cal provider manuals were assessed to see if they contained significant billing instructions for providers to continue submitting claims in the 4010A1 format. Most updates to billing instructions were considered transparent. For example:
- HIPAA 4010A1 changed to HIPAA 5010
- NCPDP telecommunication standard 5.1 changed to NCPCP D.0
- NCPDP telecommunication standard 1.1 changed to NCPDP 1.2
- Transaction and companion guide titles were updated
However, one manual page contained more complex information about the proper ANSI ASC X12N version to use. That information, from Part 1 Medi-Cal provider manual, CMC Enrollment section, page three, is captured below:
|4010 text was:||New 5010 text is:|
|Professional version (claim types 05 and 07) 004010X098A1||Professional version (claim types 05 and 07) 005010X222A1|
|Institutional version (claim types 02, 03 and 04) 004010X096A1||Institutional version (claim types 02, 03 and 04) 005010X223A2|
ASC X12N Version 4010A1 Guides
The full Implementation Guides and their corresponding Addenda can be obtained from the Washington Publishing Company website.
If you cannot view the MS Word or PDF (Portable Document Format) documents correctly, please visit the Web Tool Box to link to a download site for the appropriate reader.