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Medicare Fee-for-Service 5010 - D0

:This document contains important information on the scheduled Part A software release being moved into production for the Medicare Fee-for-Service system on March 5, 2012.

The Centers for Medicare and Medicaid Services (CMS) is underway with implementation activities to convert from Health Insurance Portability and Accountability Act (HIPAA) Accredited Standards Committee (ASC) X12 version 4010A1 to ASC X12 version 5010 and National Council for Prescription Drug Programs (NCPDP) version 5.1 to NCPDP version D.0.

The Secretary of the Department of Health and Human Services (HHS) has adopted ASC X12 version 5010 and NCPDP version D.0 as the next HIPAA standard for HIPAA covered transactions. The final rule was published on January 16, 2009. Some of the important dates in the implementation process are:

Effective Date of the regulation: March 17, 2009
Level I Compliance by: December 31, 2010
Level II Compliance by: December 31, 2011
All covered entities have to be fully compliant on: January 1, 2012

Level I compliance means "that a covered entity can demonstrably create and receive compliant transactions, resulting from the compliance of all design/build activities and internal testing."

Level II compliance means "that a covered entity has completed end-to-end testing with each of its trading partners, and is able to operate in production mode with the new versions of the standards."

HHS permits dual use of existing standards (4010A1 and 5.1) and the new standards (5010 and D.0) from the March 17, 2009, effective date until the January 1, 2012 compliance date to facilitate testing subject to trading partner agreement.

The CMS Medicare Fee-for-Service schedule is:
Level I April 1, 2010 through December 31, 2010
Level II January 1, 2011 through December 31, 2011
Fully compliant on January 1, 2012

The tabs on the left hand side of the screen contain information that is currently available on Versions 5010 and D.0.  It is important to note that there are separate resource pages for D.0 and 3.0 for tools and information specific to these pharmacy-related standards.  New tabs and downloads will be added as information becomes available.