Medicaid
Attention: All Providers and Vendors
HIPAA 5010 Implementation
The Division of Medical Assistance (DMA) started dual processing of ASC X12 5010 Transactions on November 4, 2011. DMA strongly encourages providers to take advantage of this dual processing time period to reduce potential impacts on the federally mandated ASC X12 5010 implementation date of January 1, 2012. Providers (or their vendors) must complete and submit Appendix A of the Trading Partner Agreement(TPA) to HP Enterprise Services (HPES) and successfully pass compliance testing or submit third party certification prior to submitting ASC X12 5010 Transactions into production. Appendix A is located at http://www.ncdhhs.gov/dma/hipaa/5010Appendix2.pdf.
Providers can choose to submit ASC X12 4010A1 or 5010 transactions (this includes any of the transactions noted in the table below and documented in your TPA) during the dual processing time period. Providers can move completely to the ASC X12 5010 transactions prior to January 1, 2012, use both ASC X12 4010A1 and 5010, or continue to use ASC X12 4010A1 transactions during the dual processing time period. DMA would recommend providers discuss testing and implementation plans with their vendors.
| ASC X 12 5010 Transactions | Dual Processing Start Date | Dual Processing End Date |
|---|---|---|
| 837 Dental, Institutional, Professional | 11/4/2011 | 1/1/2012 |
| NCPDP D.0 | 11/18/2011 | 1/1/2012 |
| 835 | 11/8/2011 | 1/1/2012 |
| 270/271 | 11/29/2011 | 1/1/2012 |
| 276/277 | 11/23/2011 | 1/1/2012 |
| 820 (vendors only) | 12/2/2011 | 1/1/2012 |
| 834 (vendors only) | 12/2/2011 | 1/1/2012 |
| GHI Medicare Crossover Claims | 12/20/2011 | 1/1/2012 (with two week run out) |
Note: The ASC X12 5010 278 transaction is not included in this implementation.
There are currently no providers utilizing the ASC X12 278 4010A1 278 transaction. The NC Electronic Claims Submission/Recipient Eligibility Verification Web Tool will be updated to address changes associated with ASC X12 5010 implementation on December 29, 2011.
In addition, HPES is currently testing with vendors, trading partners, and providers. Providers can contact HPES, ECS unit, at 1-800-688-6696 or 919-851-8888; press option 1 for questions or assistance regarding this information about the ASC X12 5010 implementation. DMA will continue to post informational updates on the DMA website at http://www.ncdhhs.gov/dma/hipaa/index.htm, along with monthly Medicaid Provider bulletins and special Medicaid bulletins.
HP Enterprise Services
1-800-688-6696 or 919-851-8888
Attention: All Providers and Vendors
Appendix A TPA - HIPAA 5010 Implementation
HPES must receive updated Trading Partner Agreement (TPA) - Appendix A from providers, the provider's clearinghouses or billing agents who submit electronic transactions directly to HPES no later than December 19, 2011 to ensure there is adequate time to process the appendix A prior to the federally mandated HIPAA ASC X12 5010 implementation date of January 1, 2012. Failure to provide HPES with the updated appendix A by December 19th may result in the inability to process your 5010 electronic transactions, including your claims, which could impact provider payment. DMA has been providing advance notifications regarding the necessity to update Appendix A since the July 2011 Medicaid bulletin and does not plan on issuing any cash advances as a result of a provider not being ready for 5010. In addition, DMA requires electronic billing paper claims received will be denied for not being filed electronically.
The CMS statement released on November 17, 2011 states “Today the Centers for Medicare & Medicaid Services’ Office of E-Health Standards and Services (OESS) announced that it would not initiate enforcement action until March 31, 2012, with respect to any HIPAA covered entity that is not in compliance with the ASC X12 Version 5010 (Version 5010), NCPDP Telecom D.0 (NCPDP D.0) and NCPDP Medicaid Subrogation 3.0 (NCPDP 3.0) standards. Notwithstanding OESS’ discretionary application of its enforcement authority, the compliance date for use of these new standards remains January 1, 2012 (small health plans have until January 1, 2013 to comply with NCPDP 3.0). CMS’ Office of E-Health Standards and Services is the U.S. Department of Health and Human Services’ component that enforces compliance with HIPAA transaction and code set standards.”
Providers can contact HPES, ECS unit at 1-800-688-6696 or 919-851-8888; press option 1 for questions or assistance regarding this information about the ASC X12 5010 implementation.
HP Enterprise Services
1-800-688-6696 or 919-851-8888