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ASC X12N 5010 and NCPDP D.0/1.2 Update: Transaction Testing

Updated September 19, 2012
Originally Published April 9, 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.

CMC Blackout Period for Test Files
On Monday, March 26, 2012, Medi-Cal stopped testing for 4010 batch transactions (837I, 837P, 270 batch and NCPDP 1.1).

This blackout period for Computer Media Claims (CMC) testing applies only to test files, submitted through the CMC test site. Production file submissions will not be affected. The blackout period is in preparation for 5010 and NCPDP 1.2 transaction testing. Current CMC submitters may continue to submit transactions in the 4010A1 and NCPDP 5.1/1.1 formats into production until further notice.
  • Submitters who have submitted a Medi-Cal Telecommunications Provider and Biller Application/Agreement (DHCS 6153) and have not completed and passed testing will need to test in 5010/NCPDP 1.2 formats (rather than 4010/NCPDP 1.1) once CMC testing resumes.
  • Submitters who have sent test files to CMC and successfully passed will be activated for the 4010A1/NCPDP 1.1 format into production. These submitters will need to test for the 5010/NCPDP 1.2 formats once CMC testing resumes in order to be activated to submit claims in those formats.
Testing/Certification of ASC X12N 5010 and NCPDP D.0/1.2 Transactions
Submitters must successfully test the new 5010 and NCPDP D.0/1.2 formats before sending transactions in production to Medi-Cal. Testing for this certification will be scheduled by Medi-Cal.
  • Certification is anticipated to begin May 1, 2012; submitters will be contacted and scheduled before testing begins.
  • 5010/NCPDP D.0/1.2 production files will be accepted beginning June 25, 2012, from submitters that have successfully tested for 5010 and NCPDP D.0 or 1.2 formats (whichever applies).
  • Beginning June 25, 2012, submitters will be able to send either 4010A1/NCPDP 5.1/1.1 or 5010/NCPDP D.0/1.2 transactions. While Medi-Cal will continue to accept 4010A1/NCPDP 5.1/1.1 after June 25, 2012, once submitters are activated for 5010/NCPDP D.0/1.2 transactions, they may no longer submit in the 4010A1/NCPDP 5.1/1.1 transaction standard.
  • A date for termination of the 4010A1 and NCPDP 5.1/1.1 formats will be forthcoming.
The following formats will be available for 5010 and NCPDP D.0/1.2 submission beginning June 25, 2012:
  • Internet Professional Claims Submission (IPCS)
  • Real-Time Internet Pharmacy (RTIP)

Test Instructions
Instructions for submitting test files for both batch and real-time transactions will be posted on the Medi-Cal website and sent out through the Medi-Cal 5010 mailbox.

Resources
Providers should continue to visit the Medi-Cal website for updated information. Providers with inquiries may call the Computer Media Claims (CMC) Help Desk at 1-800-541-5555, option 4 for the Technical Help Desk, followed by option 6 for CMC.