Reminder: Final Implementation Dates on the NCPDP 5.1 Transition
Currently, all durable medical equipment Medicare administrative contractors' (DMEMAC) National Council for Prescription Drug Programs (NCPDP) claims are received by Common Electronic Data Interchange (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 DMEMAC 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 DMEMAC 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 DMEMAC NCPCP 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 DMEMAC 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 DMEMAC 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
National Government Services, Inc.
Corporate Communications
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