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Wisconsin Medicaid Companion Document to HIPAA
Implementation Guide — NCPDP 5.1
Attention Providers Using the Pharmacy POS System:
The enhancement to the pharmacy POS system allowing up to two sets of DUR
fields per transaction has been delayed. The enhancement was announced in Update
2004-78. Wisconsin Medicaid will notify providers of the new implementation
date.
Effective on and after 12/14/04
NCPDP 5.1 V4
PHC 13052 (9/15/04)
PDF (113 KB)
Revision Log
Companion Document Audience
Companion documents are intended for information technology and/or systems
staff who will be coding billing systems or software for compliance with the
federal Health Insurance Portability and Accountability Act of 1996 (HIPAA).
Purpose of Companion
Documents
The information contained in this companion document applies to Wisconsin
Medicaid, BadgerCare, and SeniorCare, although the companion document only
refers to Wisconsin Medicaid.
The companion documents are designed to be used with HIPAA Implementation
Guides. Companion documents provide Wisconsin Medicaid-specific information that
details the way to create HIPAA transactions for Wisconsin Medicaid and explains
how Wisconsin Medicaid creates HIPAA transactions. Companion documents clarify
the HIPAA-designated standards usage but are not intended to supercede them. The
purpose of companion documents is to provide trading partners with a guide to
communicate the Wisconsin Medicaid-specific information required to successfully
exchange transactions electronically with Wisconsin Medicaid.
Wisconsin Medicaid will accept and process any HIPAA-compliant transaction.
However, a compliant transaction that doesn’t contain Wisconsin
Medicaid-specific information, though processed, may be denied for payment. For
example, a compliant 837 claim created without a Wisconsin Medicaid recipient
identification number will be processed by Wisconsin Medicaid, but will be
denied payment.
Companion documents highlight the data elements significant for Wisconsin
Medicaid. For transactions created by Wisconsin Medicaid, companion documents
explain how certain data elements are processed. Please refer to the companion
document first if there is a question about how Wisconsin Medicaid processes a
HIPAA transaction. For further information, contact the Division of Health Care
Financing (DHCF) Electronic Data Interchange (EDI) Department at (608) 221-9036.
VERSION 4 REVISION LOG
Companion Document:
NCPDP 5.1
Approved: 09/15/04
Modified by: mjb
| Field Number
Revised |
Page(s) Revised |
Text Revised |
|
473-7E |
12 |
Added
instructions for proper use of this field when multiple groupings of
repeatable fields 439-E4, 440-E5, 441-E6, or 474-8E are submitted. |
|
439-E4 |
13 |
Added
clarification as to how and when to submit multiple sets of the repeatable
DUR/PPS fields when overriding DUR alerts or billing PC claims. |
|
440-E5 |
14 |
Added clarification as to
how and when to submit multiple sets of the repeatable DUR/PPS fields when
overriding DUR alerts or billing PC claims. |
|
441-E6 |
15 |
Added clarification as to
how and when to submit multiple sets of the repeatable DUR/PPS fields when
overriding DUR alerts or billing PC claims. |
|
474-8E |
15 |
Added clarification as to
how and when to submit multiple sets of the repeatable DUR/PPS fields when
overriding DUR alerts or billing PC claims. |
VERSION 3 REVISION LOG
Companion Document:
NCPDP 5.1
Approved: 04/24/04
Modified by: kmc
| Field Number
Revised |
Page(s) Revised |
Text Revised |
|
442-E7 |
7 |
Clarification was added to
the Quantity Dispensed field. The field will only be rejected if more than 8
significant digits are submitted; leading zeros will not cause a
rejection. |
|
429-DT |
8 |
The Unit Dose Indicator has
been changed from ‘Required’ to ‘Required When’. |
|
448-ED |
15 |
Clarification was added to
the Compound Ingredient Quantity field. The field will only be rejected if
more than 8 significant digits are submitted; leading zeros will not
cause a rejection. |
|
530-FU |
22 |
The Previous Date of Fill
will be omitted, not zero filled, if the DUR alert set based on current
claim data only. |
|
531-FV |
22 |
The Quantity of Previous
Fill will be omitted, not zero filled, if the DUR alert set based on current
claim data only. The returned field has also expanded in size from 6 bytes
to 8 bytes. |
|
112-AN |
32 |
Wisconsin has added an
accepted transmission, rejected transaction B2 response. Therefore, the
value of ‘R’ has been added to the Transaction Response Status. |
|
510-FA |
32 |
Wisconsin has added an
accepted transmission, rejected transaction B2 response. Therefore, the
Reject Count field has been added to the Response Status Segment on an
accepted B2 transmission response. |
|
511-FB |
32 |
Wisconsin has added an
accepted transmission, rejected transaction B2 response. Therefore, the
Reject Code field has been added to the Response Status Segment on an
accepted B2 transmission response. |
|
546-4F |
32 |
Wisconsin has added an
accepted transmission, rejected transaction B2 response. Therefore, the
Reject Field Occurrence Indicator has been added to the Response Status
Segment on an accepted B2 transmission response. |
|
546-4F |
33 |
The Reject Field Occurrence
Indicator has been added to the Response Status Segment on a rejected B2
transmission response. |
VERSION 2 REVISION LOG
Companion Document:
NCPDP 5.1
Approved: 10/27/03
Modified by: kmc
| Field Number
Revised |
Page(s) Revised |
Text Revised |
|
|
20 |
The
DUR/PPS Code Counter will contain the value of 1 – 5, not 1 – 9. |
|
531-FV |
21 |
The field will be returned
in the following format: 999.999. |
|
112-AN |
30 |
Wisconsin will not return
an accepted transmission, rejected transaction B2 response. Therefore, the
value of ‘R’ (Rejected) was deleted. |
|
510-FA |
30 |
Wisconsin will not return
an accepted transmission, rejected transaction B2 response. Therefore, the
Reject Count field was deleted. |
|
511-FB |
30 |
Wisconsin will not return
an accepted transmission, rejected transaction B2 response. Therefore, the
Reject Code field was deleted. |
|
503-F3 |
31 |
The authorization number
will be returned on the rejected transmission, rejected transaction B2
response. |
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