Health Insurance Portability and Accountability Act [HIPAA] - Version D.0 (Pharmacy Claims)

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Version D.0 (Pharmacy Claims)

Version D.0 specifically addresses business requirements that have evolved with the implementation of the processes in Medical billing or Medicare prescription drug benefit (Part D) and changes within the healthcare industry.

Salient features of Version D.0:

► It provide a comprehensive information regarding eligibility for Medicare Part D and miscellaneous insurance coverage;

► Identification of patient responsibility, benefits stages and coverage gaps on secondary health claims

► Facilitate the billing of multiple ingredients in processing claims for compounded drugs and medicines.

► Improvement in claims receipt, control, and balancing procedures

► Increasing consistency of claims editing and error handling;

► Returning claims that require correction in the process.

► Assigning claim numbers nearer to the time of receipt.

The compliance date for implementing Version 5010 and Version D.0 is January 1, 2012, so as to allow sufficient time to test the proposed HIPAA standards internally, to ensure that the systems have been appropriately updated and switchover or transition to the new formats between trading partners prior to the compliance date for HIPAA. However, the rule has been relaxed for small health insurance plans which need to comply before January 1, 2013.

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