Health Insurance Portability and Accountability Act (HIPAA)

80.9 - Health Insurance Portability and Accountability Act (HIPAA) 5010 and National Council for Prescription Drug Programs (NCPDP) D.0 Crossover Requirements (Rev. 4009, Issued: 03-23-18, Effective: 04-23-18, Implementation: 04-23-18) Effective January 5, 2009, the BCRC created a new 1-byte “5010 Test/Production Indicator” and a new 1-byte “NCPDP D.0 Test/Production Indicator” on the COBA Insurance File [COIF] (valid values= “N”—not applicable or not ready as yet; “T”—test; “P”—production). The CWF maintainer shall 1) create these new fields, along with 1-byte file displacement, within its version of the COIF; and 2) accept and process these new fields when the BCRC transmits them as part of its regular COIF updates. If the BCRC transmits a value other than T, P, or N within the newly designated fields, CWF shall ignore the value. In addition, the CWF maintainer shall add a new “5010 Test/Production Indicator” and an “NCPDP D.0 Test/Production Indicator” to the BOI reply trailer (29) format. The CWF shall not post crossover disposition indicators in association with claims whose 5010 and NCPDP D.0 indicators are “N” or “T.” (Refer to §80.5 of this chapter for more information regarding claims crossover disposition indicators.)