Final Implementation Dates on the NCPDP 5.1 Transition
Attention All Common Electronic Data Interchange (CEDI) Trading Partners,
Suppliers, Billing Services, Clearinghouses, and Vendors
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 beginning November 2009 and completing in December 2009. The timeline for
this process is as follows:
? NCPDP claims received through 8:00 a.m. ET on Sunday November 8, 2009
will process at CEDI and only the DME MAC reports will be produced and returned
for these claims.
? On November 8, 2009, CEDI will utilize the Sunday maintenance window to
implement an NCPDP dual front-end process. NCPDP claims received after 8:00
a.m. ET on Sunday November 8, 2009 will be part of this dual front-end process.
Once the dual process is in place:
? CEDI will begin producing front-end reports for NCPDP claims and the
DME MACs will continue to send back the current NCPDP reports.
? The CEDI NCPDP reports will be returned in a real time mode
(immediately after a file is sent) and the DME MAC NCPDP reports will continue
to be available within 24-48 hours after a file is sent.
? Although the CEDI NCPDP reports are returned before the DME MAC NCPDP
reports, NCPDP submitters must rely on reports produced by the DME MACs to
determine the Claim Control Number (CCN), claims accepted and to identify
errors that need correcting.
? 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.
? For claims received after 5:00 p.m. on Friday December 4, 2009, the DME
MACs will discontinue all NCPDP front-end processes and the CEDI front-end
process will remain in place. At that time, only CEDI will perform NCPDP
front-end editing and produce NCPDP reports for the Trading Partners. CEDI will
also assign the CCN to accepted claims and deliver the accepted claims to the
appropriate DME MAC based on the beneficiary state code submitted on the claim.
A new CEDI NCPDP Front-End Manual is being developed to include the changes.
The new manual will be posted to the CEDI Web site (www.NGSCEDI.com) and a
Listserv will be sent once available.
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.
Thank you,
National Government Services, Inc.
Corporate Communications
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