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Wisconsin Medicaid Companion Document to HIPAA
Implementation Guide — NCPDP 5.1
Effective on and after 4/24/04
PHC 13052 (4/24/04)
PDF (197 KB)
Revision Log (4/24/04)
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 3 REVISION LOG
Companion Document: NCPDP 5.1
Approved: 04/24/04
| 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
| Field Number Revised |
Page(s) Revised |
Text Revised |
|
567-J6 |
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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