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HIPAA: ASC X12N 5010 and NCPDP 1.2 – Testing Update

August 6, 2012

This article has been updated since it was first posted. Please note the following changes from the last version:

  • There is now a reference to the CMC Billing and Technical Manual regarding the test files for 837I/837P and Pharmacy transactions.
  • There is now a reference to the RTIP tutorial.
  • There is now a reference to the IPCS tutorial.

Batch Test Notification and Guidelines
Testing for the new batch formats began in May. Submitters must successfully test the new batch 837, 270 and NCPDP 1.2 formats before sending transactions to the CA-MMIS production environment. Important points for transitioning to 5010/NCPDP 1.2 include the following:

  • To activate ASC X12N 5010 and NCPDP 1.2 batch transactions, submitters must contact the Computer Media Claims (CMC) Help Desk and communicate the date they would like to switch from submitting 4010A1/NCPDP 1.1 to 5010/NCPDP 1.2 transactions.
  • In order for providers to submit ASC X12N 5010 and NCPDP 1.2 transactions in production, they must have tested and passed all batch transaction formats that are applicable to them.
  • Once switched to 5010 and/or NCPDP 1.2, submitters will no longer be able to submit 4010A1 or NCPDP 1.1 transactions.
  • Information regarding test files for the 837 Institutional Claim, 837 Professional Claim and NCPDP 1.2 Pharmacy transactions can be found in Section 5 of the CMC Billing and Technical Manual: Testing and Activation Procedures ctm5010 05.

Test Instructions – 270 Eligibility Batch Transaction
Testing of the 270 Eligibility Batch transaction is available now. Instructions for testing 270 Batch transactions are contained in a separate document that can be accessed from the Newsroom area on the Medi-Cal website homepage:

Real-Time Internet Pharmacy (RTIP)
This application was upgraded to the 5010 format on June 25, 2012. No testing is necessary. Documentation containing HIPAA update information can be found in the RTIP tutorial:

Internet Professional Claim Submission (IPCS)
This application was upgraded to the 5010 format on June 25, 2012. No testing is necessary. Documentation containing HIPAA update information can be found as noted below:

Point of Service (POS) Device
The Point of Service (POS) device has not yet been upgraded to the 5010 and NCPDP D.0/1.2 format; a date for that upgrade has not been determined. As a result, alternatives are shown below for eligibility and claim submission in the 5010 and NCPDP 1.2 format. The device will still be available but will be in the 4010 and NCPDP 1.1 format on and after June 25, 2012.

Submitters can check eligibility with these methods:

  • Automated Eligibility Verification System (AEVS); User Guide found here: AEVS User Guide
  • Batch Internet Eligibility (via Medi-Cal website); see the Recipient Eligibility tutorial on the
    Medi-Cal Learning Portal (MLP)
  • Real-Time Internet Eligibility (RTIE), Single or Multiple Subscriber; see Recipient Eligibility tutorial noted above

Submitters can submit 837 Professional claims with these methods:

Medi-Services Reservation (MSR) feature
The Medical Services Reservation (MSR) feature will not be available in the 5010 version of the 270 Eligibility Inquiry transaction. Medi-Services can be reserved using the methods shown below:

Resources
For questions about the transactions being tested, or to sign up for a new method of submitting transactions, providers can contact the Telephone Service Center (TSC) at 1-800-541-5555 and choose the appropriate option for language (English or Spanish), then choose option 1 for provider, followed by option 4 for the Technical Help Desk, and finally option 2 for the CMC Help Desk.

Providers should continue to access the Medi-Cal website and Medi-Cal Update provider bulletins for current information about the Medi-Cal 5010 and NCPDP D.0/1.2 implementation or contact the TSC for additional assistance.