Please refer to the following categories for related frequently asked questions:
What are the version 5010 HIPAA transaction standards?
The Health Insurance Portability and Accountability Act (HIPAA) X12 Version 5010 is a new set of standards that regulate the electronic transmission of specific healthcare transactions, including eligibility, claim status, referrals, claims, and electronic remittance advice (ERA).
When will these new standards take effect?
As of January 1, 2011, Aetna, in collaboration with CVS Caremark, began testing the new ASC X12 5010 transaction version, called NCPDP D.0. Aetna began accepting both 5.1 and D.0 transactions in September, 2011. As of April 11, 2012, Aetna and CVS Caremark only accepts D.0 transactions.
Why is the standard changing from the 4010 to the 5010?
Version 5010 is in compliance with the latest federal regulations. The new file is more secure and more informative.
Will these upcoming changes affect current reimbursement rates?
Will these upcoming changes impact the turn around time of transactions with Aetna?
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When are pharmacies required to upgrade to NCPDP D.0?
January 1, 2012 was the compliance date required by law for use of the 5010 version of the X12 standards and the D.0 version of the NCPDP Telecommunication Standard. As of April 11, 2012 Aetna only accepts D.0 transactions.
When will Aetna begin testing/certification for NCPDP D.0?
Aetna has completed certification testing for D.0.
Do pharmacies need new software to submit and process claims?
Your current configuration may be incompatible with the new file formats. Please consult with your software vendor or pharmacy association to make sure you will not experience a disruption.
Where can I get Aetna’s D.0 payer sheets?
Aetna's payer sheets are available online. Visit www.aetna.com and click the "Health Care Professionals" section. Then take these steps:
A complete list of changes and discussions about the impacts of NCPDP D.0 can be found in supporting documentation from NCPDP: Final Rule as it Relates to the Pharmacy Industry.
For general questions, contact Aetna’s NCPDP D.0 mailbox: NCPDPD.0Questions@Aetna.com