HIPAA: ASC X12N Version 4010A1 Companion Guides and NCPDP Technical Specifications
Companion Guides exist for the following transactions:
- ASC X12N 270/271 Version 4010A1 Health Care Eligibility Benefit Inquiry and Response
(Real-Time and Batch) - ASC X12N 276/277 Version 4010A1 Health Care Claim Status Request and Response (Batch)
- ASC X12N 835 Version 4010A1 Payment/Advice
- ASC X12N 837 Version 4010A1 Professional and Institutional Claims
The National Council for Prescription Drug Programs (NCPDP) Telecommunication Standard, Version 5.1 Technical Specifications for pharmacy claims, including compound segment, are available in the document Medi-Cal POS NCPDP Pharmacy Transaction Specifications, Third Party Vendors (Dial-Up and Leased-Line) (1042 KB - updated July 31, 2008).
In addition, Draft NCPDP 5.1 Prior Authorization Network Specifications (304 KB) are now available. These specifications are for NCPDP 5.1 prior authorization transactions. In this draft specifications document, a shaded field indicates an optional field. If an entire segment is optional, this is noted in the text preceding the segment's specifications rather than by shading the entire segment.
NCPDP Prior Authorization transactions have been implemented into production as of March 2005. The above draft NCPDP 5.1 Prior Authorization Network Specifications has been integrated into the existing Medi-Cal POS NCPDP Pharmacy Transaction Specifications, Third Party Vendors (Dial-Up and Leased-Line) (1042 KB - updated July 31, 2008) document. Refer to the Medi-Cal POS Network Telecommunications Interface Standards, Third Party Vendors (Draft) document for more information about NCPDP transaction formatting.
Providers can review or download individual sections of each Companion Guide, or download an entire guide as a single Zip file. The NCPDP Technical Specifications are offered only as a downloadable Zip file. Change logs are included in the guides to identify and describe ongoing modifications. For more information about HIPAA or the Companion Guides, call the TSC at 1-800-541-5555 (out-of-state providers and software vendors should call [916] 636-1200).
The documents available on this page are updated on an ongoing basis to ensure that they contain the most up-to-date information. Providers and submitters are therefore encouraged to and refer to it often for the most current documents.
270/271 Version 4010A1 Health Care Eligibility Benefit Inquiry and Response Companion Guide (Real-Time and Batch Transactions)
Download the 270/271 Companion Guide as a single Zip file (1.46 MB), or view/download individual sections using the links below.
Overview (updated May 15, 2007) Data Specifications- 270 Eligibility Inquiry 4010A1 Data Specifications (updated May 15, 2007)
- 270 Spend Down and Spend Down Reversals 4010 Data Specifications (updated May 15, 2007)
- 270 Medical Services Reservation and MSR Reversals 4010 Data Specifications (updated May 15, 2007)
- 271 Eligibility Inquiry 4010A1 Data Specifications (updated July 31, 2008)
- 271 Spend Down and Spend Down Reversals 4010 Data Specifications (updated July 31, 2008)
- 271 Medical Services Reservation and MSR Reversals 4010 Data Specifications (updated May 15, 2007)
- Batch Internet Eligibility Test Transaction Instructions For 270/271 Submissions (updated February 25, 2008)
- 270 Eligibility Inquiry Transaction TA1 Interchange and 997 Functional Group Acknowledgements (updated February 25, 2008)
- Check Digit Algorithms (updated May 15, 2007)
- Provider Mail: TX Functional Group or 864 Transaction Set (updated May 15, 2007)
- 271 Eligibility Response Transaction AAA Segment Error Resolution Process (updated May 15, 2007)
- 270/271 Transactions Test Data (updated May 15, 2007)
- Medi-Cal Identification Cards Magnetic Stripe Formats
- Medi-Cal POS Network Telecommunications Interface Standards, Third Party Vendors (Draft) (updated February 20, 2008)
276/277 Version 4010A1 Health Care Claim Status Request and Response Companion Guides (Batch Transactions)
Download the 276/277 Companion Guides as a single Zip file (176 KB), or view/download individual guides using the links below.
- 276 Claim Status Request Transaction Companion Guide (updated September 28, 2007)
- 277 Claim Status Response Transaction Companion Guide (updated September 28, 2007)
835 Version 4010A1 Health Care Claim Advice/Payment Companion Guide
Download the 835 Companion Guide as a single Zip file (192 KB), or view/download individual sections using the links below.
835 ASC X12 v.4010A1 Control Specifications- Health Care Claim Payment/Advice Data Specifications (updated March 9, 2007)
- Interchange Start Control Structure Data Specifications
- Group Start Control Structure Data Specifications
- Group End Control Structure Data Specifications
- Interchange End Control Structure Data Specifications
837 Version 4010A1 Health Care Claim Companion Guide
Download the 837 Companion Guide as a single Zip file (1.36 MB), or view/download individual sections using the links below.
Submission and Billing Instructions- ANSI ASC X12N 837 v.4010A1 Tape Submissions
- Billing Instructions (updated October 27, 2006)
- Medi-Cal Electronic Billing Claim Certification and Control Sheet (Form 80-1)
- Testing and Activation Procedures
- ANSI ASC X12N 837 v.4010A1 TelePoint Submissions
- Data Specifications General Information
- CMC ANSI ASC X12 837 v.4010A1 Data Specifications
- Field Definitions and Explanations
- Inpatient Data Specifications (updated July 31, 2007; see Change Log)
- Outpatient Data Specifications (updated July 31, 2008; see Change Log)
- Long Term Care (LTC) Data Specifications (updated July 31, 2007; see Change Log)
- Medical Data Specifications (updated July 31, 2008; see Change Log)
- Vision Data Specifications (updated June 19, 2006; see Change Log)
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CMC Error Codes and Messages (updated November 2005)
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Check Digit Algorithms (updated May 2007)
- Medi-Cal Electronic Attachment and Image Specifications – Third-Party Vendors (39 Kb)
Note:
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