Implementation Schedules for HIPAA Named Transactions
This document provides information pertinent to implementation of HIPAA named transactions tracked by NCPDP Work Groups.
The information contained on this document is valid as the last update from the Work Groups, to the best of their knowledge.
Where applicable, state laws and provider manuals should be consulted for implementation guidelines.
National Council for Prescription Drug Programs
9240 E Raintree Drive
Scottsdale, AZ 85260-7518
Phone: (480) 477-1000
Fax: (480) 767-1042
Email: kkrempin@ncpdp.org
FORMAT PHARMACY NPI
FISCAL
STATE INTERMEDIARY OR DATE ACCEPTED
PAPER=P DATE BEGIN USE DATE OF
PROCESSOR (start of transition
ELECTRONIC=E IN ADJUDICATION REQUIRED USE
period)
Alabama (AL) EDS N/A 2/23/08 (coincides
with new MMIS
implementation)
Alaska (AK) First Health 5/23/07 10/31/2007
Arizona (AZ) see note below**
Arkansas (AR) EDS 5/23/07 - October or 5/19/2008
November
California (CA) EDS 4/21/08 10/1/2008
Colorado (CO) ACS 7/20/07 able to TBD
accept NPI
Connecticut (CT) EDS 5/18/07 12/4/2007
Delaware (DE) EDS P N/A 3/25/07 3/25/07
E
Dist. of Columbia (DC) ACS 5/23/07 5/23/2008
First Health
Florida (FL) (Pharmacy) 5/23/07 TBD
EDS (Medical)
NCPDP Page 2 11/16/2011
Georgia SXC 5/1/08
Hawaii (HI) ACS 5/23/2007
Idaho (ID) EDS 5/29/07
Illinois (IL) State P, E 5/23/2007 - NPI or
Legacy
Indiana (IN) EDS 3/01/07 (paper only) 5/23/2008 hard
cutover
Iowa (IA) GHS (Gould) 5/23/2008 cannot
5/23/07 - 5/23/08 reverse claims
prior to 5/23 with
Kansas (KS) EDS E 5/23/07 05/23/08
5/14/2007 NPI or
Kentucky (KY) First Health 5/14/07
Legacy
NCPDP Page 3 11/16/2011
Louisiana (LA) Unisys P, E 8/19/07 begin 8/19/07 begin 5/23/2008
accepting NPI accepting NPI
Maine (ME) GHS (Gould) No NPIs NABP
Oct. 2008
Maryland (MD) ACS 7/30/07 3/1/2008
Massachusetts (MA) ACS 5/1/07 5/23/07
Michigan (MI) First Health 4/16/07 5/23/2007
Minnesota (MN) State Legacy and NPI 5/10/2008
Mississippi (MS) ACS 5/23/07 - 11/22/07 1/1/2008
Medicaid ID or NPI
Missouri (MO) State no transition for As of
pharmacy 5/10/2008……
Billing Provider
Identifier--will
accept only the NPI
Montana (MT) ACS 8/25/07 ?
Nebraska (NE) ACS See comment.
Nevada (NV) First Health 5/17/07 5/23/2007
New Hampshire (NH) First Health 5/7/2007- 5/23/07 5/23/2007
NCPDP Page 4 11/16/2011
New Jersey (NJ) Unisys E 5/23/2007 - unable 05/23/08
to accept NPI at this
time. Legacy ID only
5/23/08
New Mexico (NM) ACS 5/23/2007 - 02/01/08 2/1/2008
New York (NY) CSC P 9/1/2008 (9/5/08 will 9/1/2008 9/1/2008
E begin testing in (legacy will be
batch-not real time) accepted until
further notice)
North Carolina (NC) EDS 5/23/08
12/07
North Dakota (ND) Noridian Now accepting the 5/23/2007 NPI
NPI (5/15/07)
Ohio (OH) ACS 5/23/07 NPI or
Legacy
Oklahoma (OK) EDS No transition for 5/23/08
phamacy
Oregon (OR) First Health (moving 4/10/2007-8/1/07 08/01/07
to EDS)
Pennsylvania (PA) EDS 6/1/2007
NCPDP Page 5 11/16/2011
Rhode Island (RI) EDS 5/29/07 1/28/2008
5/23/07 NPI
South Carolina (SC) First Health 05/23/08
Preferred
South Dakota (SD) State 5/17/08 will accept legacy
number indefinitely
First Health moving
Tennessee (TennCare) (TN) 4/24/07-5/23/07 11/23/07
to SXC 10/1/2008
Texas (TX) First Health 4/23/07 - 5/23/07 5/23/2008
Utah (UT) State Do not accept 12/1/2006 (NPI or 08/01/07
paper legacy)
Vermont (VT) MedMetrics-SXC 4/1/2008
NCPDP Page 6 11/16/2011
Virginia (VA) First Health 3/26/07-5/23/07 5/23/2007
(Medicaid or NPI)
Washington (WA) SXC - 9/1/08 5/19/08
NCPDP Page 7 11/16/2011
West Virginia (WV) Unisys E 4/22/07 accept NPI 4/22/07 6/21/07
Wisconsin (WI) EDS 5/19/08
10/1/2008
Wyoming (WY) ACS 11/30/07
NCPDP Page 8 11/16/2011
**Arizona Physicians IPA
CIGNA Community Choice
Health Choice Arizona
Maricopa Managed Care
System
Mercy Care Plan
Family Health Plan of NE
AZ
Phoenix Health Plan
Pima Health System
University Family Care
Cochise Health System
Pinal Gila Long Term Care
Plan
Evercare Select
Yavapai Long Term Care
Plan
Department of Economic
Security Developmentally
Disabled Division
Department of Economic
Security Children's Medical
Dental Program
Department of Health
Services Children's
Rehabiliation Services
NCPDP Page 9 11/16/2011
PRESCRIBER NPI PHARMACIST NPI PRIMARY PRESCRIBER NPI (Primary Car
DATE ACCEPTED DATE ACCEPTED DATE BEGIN DATE ACCEPTED
DATE BEGIN USE DATE OF DATE OF
(start of transition (start of transition USE IN (start of transition
IN ADJUDICATION REQUIRED USE REQUIRED USE
period) period) ADJUDICATION period)
none NPI and Legacy
Open ended
5/21/2008 5/21/2008
5/23/07 - October 5/19/2008
or November
10/1/2008
5/24/2008
9/1/2007
5/1/2008
N/A 3/25/07 hard
cutover
4/1/2008 5/23/2008
7/20/07 able to
5/23/2008
accept NPI
NCPDP Page 10 11/16/2011
5/1/08-5/22/08 (will
allow dual
processing of 5/23/2008
either the NPI or
legacy prescriber
5/23/08 NPI or
DEA but only in
rare instances
when NPI is not
5/23/07 - Legacy
or NPI
5/23/07 Legacy or N/A N/A N/A
NPI
5/23/2008 5/23/08 hard
cutover
5/23/08
4/1/2008
5/23/2007 4/1/2008
5/23/2008
NCPDP Page 11 11/16/2011
4/1/08 5/23/2008 - N/A N/A N/A N/A
Medicaid ID will
ony be allowed in
the prescriber ID
field when the
pharmacy is
unable to send the
prescribing
DEA number
Oct. 2008
5/23/08 will allow
override (working
out details)
5/20/08
4/16/2007 - 1/15/08 1/5/08 (does not
(NPI & Legacy ID) include MCOs)
04/01/08 5/10/2008 - N/A N/A N/A N/A
Legacy and NPI workaround for
claims with no
prescriber ID
4/30/2007 DEA or NPI
(returning NPIs in through 5/23/08
5/10/08 -
Prescribing
5/11/08 DEA or Provider Identifier--
legacy No date as will accept either
to when NPI will be the legacy MO
accepted HealthNet
provider identifier
or the DEA
8/25/2007 5/23/2008
See comment
2 year delay
NPI or Legacy 05/23/08 NPI only
Legacy ID Legacy ID
NCPDP Page 12 11/16/2011
10/3/2007 - 5/23/08 5/23/08 - n/a n/a n/a
6666666 and accepting state
5555555 will no license for
longer be accepted prescribers who
by rule are not
required to have
a NPI
11/1/2007 5/23/2008
9/1/08 9/1/2008 9/1/08 accept NPI
(legacy will be 9/1/2008 9/1/2008 9/1/2008 NPI/legacy 9/1/08
accepted until
further notice)
Until further notice 5/23/2008
continue submitting
the DEA number
as the prescriber ID
5/23/2007 NPI &
Legacy ID
5/23/07 NPI or
Legacy
No transition for Delayed until
pharmacy 5/23/08
4/10/2007 NPI No date at this
time
No later than
Legacy only 5/23/08 hard cut- N/A
over
NCPDP Page 13 11/16/2011
5/20/08-will
accept the
pharmcy NPI #
4/1/08 (currently when it is
accepting NPI or impossible to
DEA) obtain the correct
prescriber NPI. In
cases of a
hospital intern w/o
an NPI, the
5/23/08 or later
Legacy ID
will begin
unknown will accept legacy
DEA until a
solution is found
Legacy ID Legacy ID
State License State license
number number ONLY on
pharmacy claims.
any valid value 04/14/08 hard n/a n/a n/a Currently
cutover accepting NPI
5/23/2008. This is
a closed
prescriber network.
NCPDP Page 14 11/16/2011
3/16/2007 - NPI or Override available
Medicaid ID (open if no NPI, call help
ended) desk
Will not be 11/19/08
implementing approximate
pharmacy NPI until
their new Provider
One system is up
and running which
is projected for July
1, but could
change.
NCPDP Page 15 11/16/2011
4/1/08 accept NPI 5/23/08
5/19/2008 October 2008
delayed
NCPDP Page 16 11/16/2011
NCPDP Page 17 11/16/2011
INFORMATION
MARY PRESCRIBER NPI (Primary Care Physician) NPI on 835/REMIT/EFT ADDITIONAL COMMENTS
SOURCE
DATE BEGIN DATE DUAL USE
DATE OF DATE OF SOLE
USE IN (start of transition
REQUIRED USE USE
ADJUDICATION period)
Claims or other transactions
submitted using the NPI numbers
shall not be accepted until the
implementation of the new claims
processing system. Target date is
First Health
Will accept Legacy or NPI until
Arkansas Medicaid
October or November (to be
Medi-Cal 11/26/07 conversion for pharmacy
and prescriber but not hard-cutover.
Once the Pharmacy NPI is sent
cannot revert back to NCPDP
number. Must reverse claims with
pharmacy number that was
submitted on original claim.
During the contingency period either
a DEA or State License Number can
ACS
be submitted regardless of the drug
DEA class.
Delaware Medical Early Implementaion; 3/10/07 for
Assistance paper; 3/25/07 pharmacy providers;
Program NPI Alert 3/26/07 all other providers who bill
and Project electronically
First Health
NCPDP Page 18 11/16/2011
Idaho Medicaid No changes for paper - continue
receiving Legacy Provider ID and
State License Numbers. Electronic
will support either value -
crosswalking NPI to internal Legacy
Provider ID or State License
Number as appropriate.
Illinois Medicaid Illinois will be accepting either an
NPI or a legacy number for an
undetermined time period.
only accepting prescriber NPI
Kansas Health Refer to provider bulletin # 769 at
Policy Authority https://www.kmap-state-
ks.us/Public/bulletins/bulletinsearch.
asp
Refer to NCPDP companion guide
at https://www.kmap-state-
ks.us/Public/EDI/companion.asp
First Health
NCPDP Page 19 11/16/2011
N/A N/A Louisiana Expect delay in required use of
Medicaid and prescriber NPI. Will not be required
Unisys until Prescriber NPI can be
disseminated to pharmacy
community
Not yet determined
First Health
N/A N/A MN Medicaid
Nebraska State Delayed Implementation for all
Medicaid categories. Will require current
Medicaid ID numbers until further
notice. (2 year delay)
First Health
First Health
NCPDP Page 20 11/16/2011
Peter Ringel, The State expects to establish the
Unisys, New Statewide Deadline prior to May 23,
Jersey Medicaid 2008. DMAHS, in cooperation with
other State agencies, will notify
providers regarding the Statewide
Deadline for compliance with NPI
provisions. 10/3/07 will eliminate use
of 6666666 and 5555555 for all
prescribers. Can send PSN, State
license without prefix or NPI.
NY State Medicaid Delayed Implementation for all
categories. Will require current
Medicaid ID numbers until further
notice. .
EDS Will continue to adjudicate using
Medicaid Provider Number until
further notice.
OK Health Care
Authority
First Health
PA Medicaid will begin accepting
NPI numbers in both the service
provider ID field and the prescriber
ID field on 6/1/2007. Our
contingency plan allows for the
PA Medicaid submission of either the NPI number
or the legacy provider ID in the
service provider ID field. This
contingency plan will be in effect
until no later than 5/23/2008. The
prescriber ID field will allow for the
submission of either the NPI number
NCPDP Page 21 11/16/2011
Effective January 28, 2008 pharmacy
claims will reject if the pharmacy
provider NPI is missing or invalid.
First Health
First Health
TX Medicaid Texas requires the state license
number for prescribers on pharmacy
drug claims. The fee for service
claims will require the prescriber NPI
on 5/23/2008.
Accept anything Utah Medicaid
valid (using
NCPDP HCIdea
product until
NCPDP Page 22 11/16/2011
DMAS, Virginia Dual Use will also apply to
pharmacy NCPDP batch and point-
of-sale (POS) claim submissions.
However, providers will not be able
to submit both NPI and Medicaid
Provider Identification Numbers on
pharmacy batch and POS claims.
Providers will need to submit these
claims using either the NPI or
Medicaid Provider Identification
Number through the Dual Use
Washington DSHS On and after May 23, 2007, WA
DSHS will require pharmacy
providers to include their National
Council for Prescription Drug
Programs (NCPDP) Number and
Prescriber Drug Enforcement
Agency (DEA) or Prescriber
Medicaid Provider Number on all
prescription drug claims submitted
through the Point-of-Sale (POS)
system. A new POS system is in
the process of being developed by
Systems Xcellence Incorporated
(SXC) for DSHS. DSHS
implementation of NPI
requirements is not dependent
upon implementation of the new
POS system. DSHS will implement
the NPI rule within this new system
when the following have occurred:
▪ NPI data is made available within
the National Plan and Provider
Enumeration System (NPPES)
▪ SXC completes testing of the NPI
NCPDP Page 23 11/16/2011
West Virginia BMS WV Medicaid Pharmacy Program
will accept the NCPDP # as the
Provider Identifier after 5/23/07 on
paper claims only. NPI will also be
accepted as the Provider Identifier
on paper claims afte that date. The
DEA # or NPI will continue to be
accepted as the Prescriber ID on
Pharmacy POS and paper claims.
Wisconsin Delayed implementation. Require
Medicaid the eight digit Medicaid provider
number on electronic and paper
claims until further notice.
NCPDP Page 24 11/16/2011
NCPDP Page 25 11/16/2011