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 Short-Doyle Medi-Cal (SDMC).

Introduction

On October 13, 2011, the Department of Health Care Services (DHCS) announced a delay in the implementation of the HIPAA ASC X12N 5010 and the NCPDP D.0/1.2 transactions for the Medi-Cal fee-for-service (FFS) program. Transactions submitted to Medi-Cal’s FFS program must continue in the current ASC X12N 4010A1 or NCPDP 5.1/1.1 formats beyond January 1, 2012. Medi-Cal’s target implementation date for the new transactions is July 1, 2012. However, effective January 1, 2012, Medi-Cal will be able to accept and process automatic crossover claims received from the Medicare Coordination of Benefits Contractor (COBC) GHI (Group Health Incorporated). Providers should continue to visit the Medi-Cal website for updated information.

CMS 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.