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Versions 5010 and D.0 & 3.0

Important Update Regarding HIPAA Version 5010/D.0 Implementation:  This document also includes descriptions used for interpreting the 277CA responses. 

This section of the Centers for Medicare & Medicaid Services (CMS) website contains information and educational resources pertaining to:

Version 5010 -  the new version of the X12 standards for HIPAA transactions;

Version D.0 - the new version of the National Council for Prescription Drug  Program (NCPDP) standards for pharmacy and supplier transactions;

Version 3.0 - a new NCPDP standard for Medicaid pharmacy subrogation.

These versions are required by the modifications made to the Health Insurance Portability and Accountability Act of 1996 (HIPAA) in January 2009. 

As with other HIPAA standards, CMS has a dual role related to the Version 5010, D.0 and 3.0 standards.  The CMS Office of E-Health Standards & Services (OESS) is responsible for the policies and enforcement of the Administrative Simplification provisions for transactions and code sets and the National Provider Identifier (NPI) covered under HIPAA.  Other areas within CMS are responsible for systems and operations related to CMS' role as a payer of healthcare claims for the Medicare and Medicaid programs, including Medicare Fee-For-Service (FFS), Medicare Advantage and Prescription Drug Plans, and Medicaid Coordination of Benefits.

Information posted may be applicable to the healthcare industry at large, or may be specifically Medicare-related information.  This web page is designed to distinguish Medicare-related information from content that pertains to the industry at large.  For example, information that is currently posted and applicable only to Medicare FFS providers can be found under the "Medicare FFS Systems" tab on the left-hand side of the screen. 

The tabs on the left hand side of the screen contain information that is currently available on Versions 5010, D.0 and 3.0.  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 will be added as information becomes available.