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Important Testing Information for 5010A1
This article contains important information for our CEDI customers (suppliers, Trading Partners, billing services, clearinghouses and vendors). It is important you read through all of the information provided. It is important for suppliers and Trading Partners to be aware of all aspects of the transition to 5010A1 and D.0 even if you won’t be participating in the testing process.
If you have any questions, please contact the CEDI Help Desk at ngs.cedihelpdesk@wellpoint.com or at 866-311-9184.
Medicare will begin testing for the X12 837 and 835 transactions of the 5010A1 version on Friday, April 1, 2011 as well as continue testing for the 276/277 5010 transaction.
Vendors that pass the testing process can begin to move their customers into production.
The timeline for implementation:
- January 2011 – Vendors and those who do their own programming (also referred to as in-house programmers) began testing the base versions of the X12 transactions.
- January 2011 – December 2011 – Vendors/in house programmers began testing NCPDP D.0. Once testing has passed they may begin moving their NCPDP D.0 customers into production.
- April 2011 – Vendors and in-house programmers may begin testing the 5010 Errata or A1 versions of the X12 837 and 835 transactions.
- April – December 2011 – Once vendors have passed testing of the X12 5010A1 versions, they may begin moving their customers into production.
- April – December 2011 – Trading Partners will only be able to move into production for the A1 version of 5010 for the 837 and 835 transactions. The 276/277 transaction will only be used in the base 5010 format.
- April – December 2011 – Once in-house programmers have passed testing of the X12 A1 versions, they may move into production.
- January 1, 2012 – ONLY 837 and 835 5010A1, 276/277 5010, and D.0 transactions will be allowed.
ONLY Vendors and in-house programmers are required to test the claims transactions. Vendors may choose to test the other transactions including the 276/277 and 835 transactions. Vendors and in-house programmers should already have a test Trading Partner ID setup with CEDI. This ID will start with “V089”. If you are a vendor or in-house programmer and you aren’t sure if you have a test Trading Partner ID or if you need to request one, please contact the CEDI Help Desk at ngs.cedihelpdesk@wellpoint.com.
Software Vendor testing (for X12 format):
- Ability to support 5010A1 test and 4010A1 production;
- Test all claim types supported by clients;
- Test MSP claims;
- Test receipt and translation of 999 acknowledgement to text report;
- Test receipt and translation of 277 Claims Acknowledgement to text report
- Compare 835 5010A1 against production 835 4010A1
- Test 276/277 in 5010 format
Production Criteria:
- 100 percent compliant with Level 1 (translator edits)
- 95 percent compliant with Level II (business/Medicare edits)
- Vendors will work with their CEDI Trading Partner customers to determine when the Trading Partners are ready to move to production
835 Electronic Remittance Advice testing: If a Trading Partner elects to test the 5010A1 835 electronic remittance advice, it will be produced from the DME MACs production environment in parallel with the current production 4010A1 ERA.
276/277 Claim Status Request/Response testing: The 276 transaction can be sent as a test file to produce the CEDI 277 created response showing any front end errors on the 276. However, 276 files sent with a “Test” indicator will not be forwarded to the DME MAC to produce the 277 Claim Status Response. CEDI recommends testing of the 276/277 be done by sending a small 5010 276 file (no more than 5 requests) with a "Production" indicator. If the 5010 276 passes the CEDI front end edits, it will be forwarded to the DME MAC to produce the 277 Response transaction. The production 277 will then be returned for the Trading Partner to review.
Note: The 276/277 transactions will use only the base version of the 5010 format.
As part of the transition to 5010A1, the following reports will be returned:
- TRN will continue to be sent by CEDI for 5010A1 as it is today for 4010A1
- TA1 will be sent by CEDI for 5010A1 837 and 5010 276 transactions only when requested by sending the indicator to receive the TA1 within the 837 and 276 (ISA14; 0 = No 1 = Yes)
- 999 for X12 5010A1 837 and 5010 276 transactions
- 277CA for X12 837 transactions
- 277 claim status response for X12 version 5010 276 transactions as it is today for 4010A1
- DME MAC Front End Report with accepted claims received and CMN rejections for 5010A1 claims as it is today for X12 4010A1 submissions
The following reports will no longer be sent for 5010A1
- 997 for X12 837 and 276 transactions
- CEDI GenResponse for X12 837 transactions
Report Format Changes:
The 277CA will be replacing the CEDI GenResponse report and is an X12 formatted transaction. It will be necessary for software vendors to support the 277CA for their customers and we are expecting vendors will create a tool to translate the 277CA into a readable format. CEDI will not provide support to Trading Partners in how to read a 277CA.
Version D.0:
Version NCPDP D.0 began testing January 2011. If you still need to test for this transaction, please contact the CEDI Help Desk at ngs.cedihelpdesk@wellpoint.com with your vendor information.
As part of the transition to D.0, the following reports will be returned:
- TRN will continue to be sent by CEDI for D.0 as it is today for 5.1
- NCPDP Transmission Response Report for version D.0
The following reports will no longer be sent for D.0
- CEDI NCPDP Error Report for NCPDP version 5.1 transactions
- EDI Submission Summary Report NCPDP version 5.1 transactions
Report Format Changes:
The current CEDI NCPDP error report and Submission Summary Report are both being replaced by the NCPDP Transmission Response, and like the 277CA, will need to be translated into a readable format by vendors for their customers.
Additional Information:
CEDI has created a page on our web site dedicated to the upcoming transition to the 5010A1 and D.0 formats. Go to the CEDI Web site at www.ngscedi.com and select “5010 and D.0 Implementation Information”. There is an FAQ as well as links to the CMS 5010 and D.0 Web page and to the X12 and NCPDP Web sites to purchase the guides.
Companion Documents for the 5010 and D.0 transactions and are available on the CEDI Web site under Technical Specifications. These documents are intended to be used as a reference in addition to the Technical Reports (TR3), NCPDP standard implementation guides, and other reference documents.
Post Date 03/23/2011
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