Wisconsin Medicaid HIPAA Companion Document to HIPAA Implementation Guide: X12 NCPDP 5.1

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Wisconsin Medicaid Companion Document to HIPAA Implementation Guide — NCPDP 5.1

NCPDP 5.1 V6 (Revised)
PHC 13052 (9/07)
PDF (150 KB)
Revision Log
Table of Contents

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 6 REVISION LOG

Companion Document: NCPDP 5.1
Approved: 09/07/07
Modified by: AW

Field Number Revised	Page(s) Revised	Text Revised
442-E7	11	Text was incorrectly omitted from 01/01/07 and 02/01/07 companion documents.
429-DT	13	Text was incorrectly omitted from 01/01/07 and 02/01/07 companion documents.
473-7E	15	Text was incorrectly omitted from 01/01/07 and 02/01/07 companion documents.
439-E4	16	Text was incorrectly omitted from 01/01/07 and 02/01/07 companion documents.
440-E5	17	Text was incorrectly omitted from 01/01/07 and 02/01/07 companion documents.
441-E6	18	Text was incorrectly omitted from 01/01/07 and 02/01/07 companion documents.
474-8E	19	Text was incorrectly omitted from 01/01/07 and 02/01/07 companion documents.
448-ED	20	Text was incorrectly omitted from 01/01/07 and 02/01/07 companion documents.
567-J6	26	Text was incorrectly omitted from 01/01/07 and 02/01/07 companion documents.
546-4F	36, 38	Field was incorrectly omitted from 01/01/07 and 02/01/07 companion documents.

Companion Document: NCPDP 5.1
Approved: 09/07/07
Modified by: AW

Field Number Revised	Page(s) Revised	Text Revised
439-E4	26	Addition of DUR alerts NS and SR.
Attachment 3	44	Addition of DUR alerts NS and SR.

Companion Document: NCPDP 5.1
Approved: 12/21/06
Modified by: AW

Field Number Revised	Page(s) Revised	Text Revised
408-D8	12	Addition of Dispense As Written values 5 and 6.

Companion Document: NCPDP 5.1
Approved: 12/5/06
Modified by: ym

Field Number Revised	Page(s) Revised	Text Revised
104-A4	9, 29	Clarifies the use of this field for Medicare Part D SeniorCare participants.

VERSION 5 REVISION LOG

Companion Document: NCPDP 5.1
Approved: 03/05/05
Modified by: dwr

Field Number Revised	Page(s) Revised	Text Revised
473-7E	13	Clarified 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	14	Added further clarification as to how and when to submit multiple sets of the repeatable DUR/PPS fields when overriding DUR alerts or billing Pharmaceutical Care.
440-E5	15	Added further clarification as to how and when to submit multiple sets of the repeatable DUR/PPS fields when overriding DUR alerts or billing Pharmaceutical Care.
441-E6	16	Added further clarification as to how and when to submit multiple sets of the repeatable DUR/PPS fields when overriding DUR alerts or billing Pharmaceutical Care.
474-8E	17	Added further clarification as to how and when to submit multiple sets of the repeatable DUR/PPS fields when overriding DUR alerts or billing Pharmaceutical Care.

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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