Академический Документы
Профессиональный Документы
Культура Документы
Business:
• Added elements needed/wanted in adjudication
• Impact of missing elements
• Impact of changes in usage notes
• Impact of changes in transaction structures within the transaction and across
transactions [i.e., if payment must be identified at the line level on the 835 –
how do you do that when AHCCCS pays an overall tier at the header level?]
• Identify all the documentation that will need to be updated
Transactions
II. Provisions of the Proposed Rule
a. Proposed adoption of Accredited Standards Committee X12 (ASC X12) Version
005010 Technical Reports Type 3 for HIPAA Transactions
b. Proposed adoption of the National Council for Prescription Drug Programs
(NCPDP) Telecommunication Standard Implementation Guide Version D,
Release 0 (D.0) and Equivalent Batch Standard Batch Implementation Guide,
Version 1, Release 2 (1.2) for Retail Pharmacy Transactions
c. Proposed adoption of a standard for Medicaid Pharmacy Subrogation: NCPDP
Medicaid Subrogation Standard Implementation Guide, Version 3.0 for pharmacy
claims
d. Proposal to adopt NCPDP Telecommunication Standard D.0 and ASC X12
Version 005010 Technical Reports Type 3 for billing retail pharmacy supplies and
services
e. Proposed Modifications to Descriptions of Transactions
f. Proposed Compliance and Effective Dates
1
HIPAA MANDATED TRANSACTIONS
Per the final Rules Preamble: Level 1 – Acceptance Testing Period Begins (including Trading Partner Testing) and Level 2 –
Full Compliance (Transaction Version Implementation)
NEW TRANSACTIONS
** Concurrently evaluate the ability to generate necessary Subrogation 837 transactions (4010 to 5010), as needed.