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From: Aetna (HIPAA) September 23, 2003 The health Insurance Portability Accountability Act (HIPAA) of 1996 requires covered entities to utilize the NCPDP version 5.1 transaction for electronic drug prescription claim effective October 16, 2003. The information on the Payer sheet is required for on-line prescription claim transmissions submitted for adjudication to Aetna effective October 16, 2003. Although we recommend that pharmacy providers utilize the NCPDP version 5.1 transaction, Aetna has the flexibility to continue accepting the non-HIPAA compliant version 3.2 transaction for on-line prescription claim transmissions on or after the October 16, 2003 compliance date. We have established procedures for testing NCPDP 5.1 claim submissions from providers to assist them in achieving HIPPA compliance of 5.1 claim submissions as soon as possible. This approach is consistent with the guidance provide by the Centers for Medicare & Medicaid Services (CMS). If you should desire to test NCPDP 5.1 claim submissions with Aetna prior to October 16, 2003, please contact Aetna's Provider Helpline at 1-800-238-6279. As a service to participating pharmacy providers, Aetna contracted with switching companies Web MD and NCPDP to convert al non-compliant NCPDP version 5.1 non-drug pharmacy claim submissions to a HIPAA compliant ANSIX12 format. However, given the recent CMS guidance that allows pharmacies to continue to use their current transaction format as a contingence measure provided they can otherwise demonstrate good faith efforts to achieve HIPAA compliance, Aenta is not activating this capability at this time. Pharmacy providers should consult with their legal advisors regarding the full text of the CMS guidance (available at http://aspe.hhs.gov/admnsimp/). In the event you still desire to activate a conversion process for your non-drug pharmacy claim submissions, contact Aenta's Provider Helpline to receive information about the switching companies who offer this conversion capability. Pharmacy providers, at their own expense, may independently arrange for the conversion directly with these companies, if they choose. Please remember that any participating pharmacy that wants to submit non-drug pharmacy claims using ANSIX12 837 transactions dataset, will need to contact Aetna's Provider Helpline at 1-800-238-6279 and your switching company for specific details. This is a reminder to providers of a communication from a previous mailing. We look forward to working collaboratively with you to help facilitate compliance. Maryanne Grant Assistant Vice President, Network Management |
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