On October 13, 2011, the Department of Health Care Services (DHCS) announced a delay of the HIPAA ASC X12N 5010, and the NCPDP D.0 and 1.2 version implementations for the Medi-Cal fee-for-service (FFS) program. The continued use of the current ASC X12N 4010A1, and NCPDP 5.1 and 1.1 standard transactions is projected for up to one year beyond January 1, 2012.

CMS Compliance Announcement

The compliance date for the implementation of Version 5010, and NCPDP D.0 and 1.2 transactions remains January 1, 2012; however, the Centers for Medicare & Medicaid Services’ (CMS), Office of E-Health Standards and Services (OESS) announced an Enforcement Discretion period of 90 days. Information on the CMS announcement is available in a November 17, 2011 news article titled Centers for Medicare & Medicaid Services’ Office of E-Health Standards and Services Announces 90-Day Period of Enforcement Discretion for Compliance with New HIPAA Transaction Standards on the CMS website.

Providers may visit the Answers page of the U.S. Department of Health and Human Services’ website for additional information and answers to frequently asked questions on the newly mandated transaction standards.

What’s Next?

Crossover Claims

Effective January 1, 2012, Medi-Cal will be able to accept and process electronic crossover claims received from the Medicare Coordination of Benefits Contractor (COBC) GHI (Group Health Incorporated). Currently, Medi-Cal receives electronic 837I, 837P and NCPDP crossover claim files from the Medicare COBC GHI. These electronic crossover claims, commonly referred to as “automatic crossover claims,” are transmitted by the COBC to Medi-Cal for processing without provider intervention. Effective January 1, 2012, the returned 835 Remittance Advice will continue to be transmitted in the ASC X12N 4010A1 format.

Crossover claims directly billed to Medi-Cal must continue in the current ASC X12N 4010A1 or NCPDP 5.1/1.1 formats until further notice.

ASC X12N 5010 Transactions

Medi-Cal’s target implementation date for all other ASC X12N 5010 transactions is July 1, 2012.
The ASC X12N Companion Guide (CG) was released on October 1, 2011. The November 2011 Medi-Cal Update article titled HIPAA 5010 Companion Guides Released, contains links to both the HIPAA 5010 Medi-Cal CG and to a previous article that describes the new CG format.

Transaction Type	Title	Current Version	New Version
270/271	Health Care Eligibility Benefit Inquiry and Information Response	ASC X12N/004010X092 and associated errata A1	ASC X12N/005010X279 and associated errata A1 *
270/271	Health Care Eligibility/Spend Down/Spend Down Reversal	ASC X12N/004010X092 and associated errata A1	ASC X12N/005010X279 and associated errata E1 and A1 *
276/277	Health Care Claim Status Request and Response	ASC X12N/004010X093 and associated errata A1	ASC X12N/005010X212 and associated errata E1 and E2 *
835	Health Care Claim Payment/Advice	ASC X12N/004010X091 and associated errata A1	ASC X12N/005010X221 and associated errata A1 and E1 *
837I	Health Care Claim: Institutional	ASC X12N/004010X096 and associated errata A1	ASC X12N/005010X223 and associated errata A1, A2 and E1 *
837P	Health Care Claim: Professional	ASC X12N/004010X098 and associated errata A1	ASC X12N/005010X222 and associated errata A1 and E1 *

* X12 errata published July 30, 2010; X12 errata and NCPDP corrections mandated October 13, 2010 via notice in the Federal Register.

NCPDP D.0 and 1.2 Transactions

Medi-Cal’s target implementation date for NCPDP D.0 and 1.2 batch transactions is July 1, 2012.
The NCPDP Payer Sheet will be released in December 2011 and will be accessible from the Medi-Cal website.

Transaction Type	Title	Current Version	New Version
NCPDP D.0	Retail Pharmacy: Real Time	NCPDP 5.1	NCPDP D.0, republished August 2010 *
NCPDP 1.2	Retail Pharmacy: Batch	NCPDP 1.1	NCPDP 1.2

* X12 errata published July 30, 2010; X12 errata and NCPDP corrections mandated October 13, 2010 via notice in the Federal Register.

Transaction Testing

The following is the planned schedule for the testing of ASC X12N 5010, and NCPDP D.0 and 1.2 transactions. Beta testing will occur with a group of ASC X12N 5010, and NCPDP D.0 and 1.2 submitters before the mass on-boarding of all submitters begins.

Task	Target Dates
Beta Testing with ASC X12N 5010, and NCPDP D.0 and 1.2 submitters	March – May 2012
Begin Provider/Biller testing for on-boarding of ASC X12N 5010 and NCPDP D.0 transactions	July 1, 2012
Complete on-boarding of submitters for ASC X12N 5010 and NCPDP D.0 Implementation	December 31, 2012

Managed Care/Short-Doyle Programs

Separate meetings are in progress to identify and address solutions for Short-Doyle Medi-Cal (SDMC) and Medi-Cal Managed Care Program (MMCP) as they relate to recipient eligibility, spend downs and reversals; carved out FFS claims; files, reports and any other items affected by Medi-Cal’s FFS ASC X12N 5010, and NCPDP D.0 and 1.2 delayed implementation. For SDMC, the current status of 5010 implementation for the Department of Mental Health (DMH) and the Department of Alcohol and Drugs Programs (ADP) SDMC claiming is provided during a weekly scheduled County/trading partner call with listed departments. Please refer to the SDMC - DMH - SD/MC Phase II page of the DMH website for current agenda and issue information.

Resources

Medi-Cal is conducting a survey to gather information on the ability and willingness of providers and claim submitter communities to continue submitting the current ASC X12N 4010A1 and NCPDP 5.1/1.1 versions beyond January 1, 2012, as well as beyond the 90-day Enforcement Discretion period ending March 31, 2012. Separate surveys are in progress to identify and address solutions for SDMC.

Providers should continue to access the Medi-Cal website and Medi-Cal Updates provider bulletins for updated information on the 5010, and D.0 and 1.2 implementation. In the interim, providers may send suggestions or concerns to their DHCS representative or email the Medi-Cal5010@acs-inc.com mailbox.