HIPAA: HIPAA Implementation Schedule
August 27, 2003
To view the updated HIPAA Implementation Schedule click on the PDF image.
HIPAA ASC X12N Claims and Remittance Implementation Schedule
On April 29, 2002, Medi-Cal upgraded its pharmacy claims processing system to National Council for Prescription Drug Programs (NCPDP) Telecommunication Standard, Version 5.1 for online, real-time submission of pharmacy claims and NCPDP Batch Standard, Version 1.1 for batch submission of pharmacy claims. NCPDP Telecommunication Standard, Version 3.2 claims will no longer be accepted beginning October 1, 2003.
Medi-Cal is preparing to implement other standards to comply with the Health Insurance Portability and Accountability Act (HIPAA). These standards, effective for dates of service on or after September 22, 2003, include:
- The Accredited Standards Committee (ASC) X12N claim (837 Institutional, 837 Professional) transactions
- The ASC X12N Remittance Advice (835 electronic remittance advice for all claim types) version 4010A1 transaction
- A portion of internal and external code set conversions for both hard copy and electronic claims
- The ability to receive and process Medicare crossover claims from intermediaries and carriers
- NCPDP Telecommunication Standard 5.1 for compound drug claim submission
Code Sets
The code sets implementation effective for dates of service on or
after September 22, 2003 includes the following:
- Healthcare Common Procedure Coding System (HCPCS) 2003 update
- Conversion of local HCPCS codes to national HCPCS codes for:
- Orthotics and Prosthetics
- Immunizations and Vaccines
- Adoption of national code sets within the ASC X12N 835 Remittance transaction:
- Adjustment Reason Codes
- Health Care Remarks Codes
- Elimination of local Medi-Cal codes and adoption of nationl codes for the following:
- Delay Reason Codes (Formerly Billing Limit Exception Indicators)
- Place of Service Codes
- Patient Status Codes
- Medicare Status Codes
- Elimination of local Medi-Cal codes and adoption of national codes on UB-92 inpatient and outpatient claims for the following:
- Condition Codes
- Value Codes
- Revenue Codes
- Conversion of inpatient surgical procedure codes from HCPCS and CPT-4 to ICD-9-CM Volume 3 codes
For more information about HIPAA, call the Provider Support Center (PSC) at 1-800-541-5555 and select prompt option "4." Out-of-state providers and software vendors should call (916) 636-1000 and ask for the HIPAA Help Desk.
Note:
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