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| Attention All CEDI Trading Partners, Suppliers, Billing Services, Clearinghouses, and Vendors CMS Change Request 6507 - VMS Modifications to Implement the Common Electronic Data Interchange (CEDI) System, Part III, NCPDP 5.1 Implementation Currently, all durable medical equipment Medicare administrative contractors (DME MAC) National Council for Prescription Drug Programs (NCPDP) claims are received by CEDI, but are not edited or translated within CEDI. Instead, CEDI passes the NCPDP claims to the DME MACs based on the contractor code in the file and the editing and translation are performed at the DME MACs. The DME MACs also assign the Claim Control Number (CCN) to accepted NCPDP claims. The current NCPDP front-end process will be transitioning from the DME MACs to CEDI. To prepare for the upcoming changes, CEDI is currently working on their front-end system. CEDI is planning to create an NCPDP front-end report that will closely match the current DME MAC NCPDP report formats. There will be minor changes to the format of the front end reports and the front-end edit numbers will be changing from the current DME MAC numbering scheme of 6#### to the CEDI format of N####. Updates will be made to the NCPDP Error Code Manual to include these changes. Sample reports and the updated manual will be provided to the DME MAC supplier community once available. In November 2009, CEDI expects to begin performing the new NCPDP function in parallel with the current process. During this parallel processing, CEDI will produce front-end reports and continue to forward all NCPDP claims to the DME MACs for their editing, translation, CCN assignment and report production. NCPDP submitters will receive reports from both CEDI and the DME MACs. During this time, NCPDP submitters must rely on reports produced by the DME MACs to identify errors that need correcting and to identify the claims accepted. CEDI will be comparing the reports produced by CEDI and the DME MAC to make any changes to the CEDI NCPDP editing and/or reporting process. CEDI will look for feedback from the NCPDP submitters and software vendors on the new CEDI process. In December 2009, CEDI expects to move fully into production with the NCPDP process changes. At that time, CEDI will perform NCPDP front-end editing, assign the CCN to accepted claims, create flat files for delivery to the appropriate DME MAC based on the beneficiary state code and return all CEDI produced front-end reports to the Trading Partner. The DME MACs will turn off their front-end edits/reports and CCN assignment at that time. Questions on the changes to the NCPDP front-end process may be directed to the CEDI Help Desk at ngs.cedihelpdesk@wellpoint.com or 1-866-311-9184. |
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