RCPA - Rehabilitation and Community Providers Association


HIPAA 5010/NCPDP D.0 Implementation Starts January 1, 2012
December 19, 2011

The Department of Public Welfare (DPW) has reinforced that implementation of HIPAA 5010/NCPDP D.0 transaction standards will take place January 1, 2012. A Centers for Medicare and Medicaid Services (CMS) bulletin published November 17 delays enforcement for 90 days, but DPW has not delayed implementation. Providers must meet the HIPAA 5010 standards by January 1. In order to clarify the compliance date, DPW issued QuickTip #116. The department also provided internet virtual classroom training in December and can provide additional training if needed. As previously reported, all submitters are required to certify 837 and NCPDP transactions. Submitters were encouraged to contact the HP Certification Help Desk to receive a certification packet when they were ready to certify (http://www.dpw.state.pa.us/provider/promise/certification/index.htm; 717-763-5809, option #1; or pahipaa5010@hp.com).

The MA Fee-for-Service (FFS) Program Cut-Over schedule as noted in the December Provider News is:

December 19
PES v3.58 is available for providers to download. Once installed, v4010 claims can no longer be submitted.

December 27 (11:59 p.m.) 
FFS v4010 batch 837 claims no longer accepted

December 29 (11:59 p.m.) 
v4010 batch 270 (Eligibility) will no longer be accepted
v4010 batch 276 (Claim Status) will no longer be accepted (Batch 271 Eligibility response and 277 Claim Status response will process if received by 11:59 p.m., December 29)

December 31 (5:30 p.m.)   
Interactive NCPDP v5.1 and EVS transactions will not be available
All v4010 and v5.1 Internet Applications will no longer be available.
PROMISe will shut down.

January 1 (8:00 a.m. – 12:00 p.m.)
Production Validation – All v5010 and vD.0 FFS-related batch transactions accepted
All v5010 and vD.0 Internet applications restarted.
PROMISe will restart.

If the provider’s software vendor or clearinghouse is not ready for January 1 implementation, Professional, Institutional, and Dental providers can submit claims through the PROMISe Internet Portal or by paper transaction. Pharmacy providers can submit through the PROMISe Internet Portal. All providers must submit a valid diagnosis code on medical claims.

CMS has also issued updates on 5010 implementation, including fact sheets on the ICD-10 web site (https://www.cms.gov/ICD10). 

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