On January 16, 2009, the Office of the Secretary of the Department of Health & Human Services (DHHS) released regulations adopting updated versions of the standards for electronic transactions. The regulations set the compliance date for use of the new X12N Version 5010 and the National Council for Prescription Drug Programs (NCPDP) Version D.0 and 1.2 standard transactions effective January 1, 2012. The Department of Health Care Services (DHCS) has been working with the new DHCS Fiscal Intermediary (FI), Affiliated Computer Services (ACS), to modify the California Medicaid Management Information System (CA-MMIS) to accept and process the newly mandated Health Insurance Portability and Accountability Act (HIPAA) electronic transaction versions.

Due to the considerable complexities of this project, the short timeframe to convert the large group of electronic claim submitters and the competing priorities of the transition from HP Enterprise Services (the outgoing FI) to ACS, Medi-Cal is unlikely to meet the scheduled deadline of January 1, 2012 to accept the latest version of standard electronic health care transactions, including those for medical and prescription drug claims. Although DHCS continues to work toward solutions that would accept the new versions, including crossover claims directly billed to Medi-Cal, Medi-Cal’s fee-for-service providers and billers should plan for continued use of the current X12N 4010A1 and NCPDP 5.1 and 1.1 standard transactions for up to one year beyond January 1, 2012.

DHCS recognizes that the timeframe is a change to the previously published schedule and that the continued use of the X12N 4010A1 and NCPDP 5.1 and 1.1 standard transactions may be an issue for providers and billers. This provider communication serves as the first of several DHCS outreach efforts to ensure that providers know the status of the X12N 5010 and NCPDP D.0 and 1.2 implementation and how best to prepare. In the coming weeks, DHCS will release provider bulletins, update the Medi-Cal website, including frequently asked questions, attend provider association meetings and conduct training sessions. Testing dates and details will be published as soon as they are confirmed.

In the interim, if providers have suggestions or concerns about DHCS’ proposed approach, they should contact their DHCS representative or send an email to Medi-Cal5010@acs-inc.com, so that inquiries can be handled in a timely manner.

Thank you for your continued participation in the Medi-Cal program.