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HIPAA: NCPDP D.0 and 270 Real-Time – Testing and Certification Update

August 6, 2012

As previously announced, Medi-Cal began accepting and transmitting ASC X12N 5010 and NCPDP D.0/1.2 transactions on June 25, 2012. Details regarding the testing and certification processes for NCPDP and 270 Eligibility Real-Time transactions are shown below.

Real-Time 270 Eligibility Certification
Real-time 270 eligibility certifications began on June 25, 2012. Medi-Cal encourages submitters to certify their real time transactions; however, certification of real time transactions will not be required. Test case documents for 270 real-time transactions can be found on the Newsroom area of the Medi-Cal website.

NCPDP D.0 Certification
Medi-Cal needs the software vendors to certify their D.0 software only. The software vendor will need to call the POS/Internet Help Desk and provide their three-digit Vendor ID, four-digit software version and three-digit Submitter ID. Vendors contacting the Help Desk (1-800-541-5555) should enter the appropriate option for language (English or Spanish), option 1 for provider, option 4 for Technical Help Desk, followed by option 2 for POS/Internet Help Desk. The Help Desk will then update the system with the software version. The vendor can test the software by either submitting the transactions, if they have a valid submitter ID, or having a selected few Medi-Cal approved submitters send test transactions using the new version. Testing is encouraged, but not required.

The transactions require the software version be included as noted in the NCPDP D.0 Payer Sheet. Once the vendor’s test is submitted successfully, the Help Desk will update the system indicating the software version is approved for production. Any submitter can then submit NCPDP D.0 transactions in production as long as they include the approved software version in their NCPDP D.0 transaction. The NCPDP D.0 Payer Sheet and the NCPDP D.0 Testing Document can be found in the Newsroom Tab on the home page of the Medi-Cal website, as follows.

Example:
Software Vendor contacts POS Help Desk on June 25, 2012 and provides necessary information (see 110AK Segment on page 2 of the D.0 Payer Sheet). Help Desk staff updates system with this information. The software vendor then follows the instructions in the NCPDP D.0 Real-Time Testing Document and submits the pre-defined test cases on June 25, 2012. Testing results are available the next day, so if test results are successful, then the Pharmacy Submitter may begin submitting NCPDP D.0 Real-Time transactions in production on June 26, 2012.

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), option 1 for provider, option 4 for the Technical Help Desk, followed by option 2 for the POS/Internet Help Desk.

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