NCPDP D.0 Penalties Temporarily Delayed for Noncompliant Providers

NCPDP D.o Penalties Temporarily Delayed for Noncompliant Providers

On November 17, 2011, the Centers for Medicare & Medicaid Services (CMS) announced that it will delay enforcement of the required Health Insurance Portability and Accountability Act (HIPAA) new ASC X12 Version 5010 (Version 5010), the National Council for Prescription Drug Programs (NCPDP) Telecom D.0 (NCPDP D.0), and NCPDP Medicaid Subrogation 3.0 (NCPDP 3.0) standards for electronic healthcare claims until March 31, 2012. Please note: This is not a delay of the January 1, 2012 required compliance date, but a delay in the enforcement of penalties associated with provider's noncompliance.

Providers are expected to be compliant January 1, 2012, but the Indiana Health Coverage Programs (IHCP) will accommodate the grace period by accepting both versions D.0 and 5.1, and batch 1.1 and 1.2 claims starting January 1, 2012, for a period of time to be determined by the IHCP.

The submission of 5.1 claims will be closely monitored. If your pharmacy will not be ready to comply with the new HIPAA standards January 1, 2012, you must submit an email with a subject line stating "Noncompliance." The body of the email must contain your National Provider Identifier (NPI), the date you will be ready, and what steps you are taking to become compliant. Providers or their representative headquarters must send the email to no later than December 21, 2012. The IHCP reserves the right to discontinue acceptance of 5.1 claims at any time within the 90-day grace period. Please monitor for future notifications.

Providers must use new forms for paper claims and adjustments beginning January 1, 2012. The new paper forms can be found on the Forms page of on or after December 15, 2011.