Point of sale (POS)
POS or D.0 pharmacy submitters must refer to the NCPDP Implementation Guide for basic instructions for D.0 requirements. NCPDP members access the guide through the NCPDP website.
Review the Minnesota Medicaid Version D.0 NCPDP Payer Sheet (DHS-7616) (PDF) for more detailed information about Medicaid D.0 NCPDP transaction requirements.
MN–ITS Interactive or DDE is HIPAA-compliant and follows standards outlined in the Minnesota Uniform Companion Guides.
Testing is not required for MN–ITS DDE.
The MN–ITS DDE application and related user guides comply with 5010 requirements.
You are able to copy, replace and void claims regardless of the date of submission. You must include 5010 required values and diagnosis codes when copying or replacing claims. Validate the claim to confirm all necessary fields are completed.
Claim transactions (837P, 837I, 837D)
MHCP follows the AUC guidelines and best practices established for professional, institutional and dental health care claims to comply with requirements.
MHCP remittance advice (RA) (835)
Refer to Minnesota Uniform Companion Guide for Health Care Claim Payment/Advice (835) (PDF) for 5010/NCPDP requirements. MHCP will:
Eligibility inquiry and response (270/271)
MHCP follows the AUC guidelines for Health Care Eligibility Benefit Inquiry and Response (PDF) (270/271) and best practices to comply with implementation requirements.
Acknowledgements (TA1, 999)
Refer to the Minnesota Uniform Companion Guides for the following acknowledgment guidelines:
Unless rejected for one of the following, MHCP will return an additional HTML report with X12 data for rejected TA1s and 999s:
|Code||AK905 (Functional group syntax error code)||Error condition|
|006||Invalid Interchange Sender ID||Trading Partner is not authorized because the Success Message confirmation has not been received for this transaction type during testing, or
ISA06 Interchange Sender ID is not the same as the MN–ITS Mailbox ID
|009||Unknown Interchange Receiver ID||ISA08 Interchange Receiver ID must be 41-1674742|
|020||Invalid Test Indicator Value||ISA15 must be P in all environments Production/ATST/Testing|
|022||Invalid Control Structure||Multiple ISA/IEA is not allowed per file|
|024||Invalid Interchange Content
(for example, Invalid GS Segment)
|Multiple GS/GE for the same functional group is allowed, but different functional groups within an ISA/IEA are not allowed (that is, one 270 functional group and a second 837 functional group within the same ISA/IEA)|
|Code||AK905 (Functional group syntax error code)||Error condition|
|1||Functional Group Not Supported||GS01/GS08 must be one of the 5010 Inbound Transactions (for example, 837P (X222A1), 837I (X223A2), 837D(X224A2), 270 (X279A1), 276 (X212)|
|13||Unknown Security Recipient||GS03 Receiver ID must be 41-14674742|
|14||Unknown Security Originator||GS02 Sender ID must be the NPI/UMPI and must be the same as ISA06|
Authorization request (278)
MHCP developed an implementation guide for submitting 5010 X12 authorization request (278) transactions.
Request status (276/277)
MHCP developed an implementation guide for submitting 5010 request status (276) transactions.
If you submit X12 or NCPDP batch files using proprietary software, follow these steps:
Batch file size
MHCP requests you submit no more than the number specified within a batch file for the following transaction sets. Files in excess of the numbers below may require manual intervention and result in delays in processing and payment.
Use the following file structure guidelines to submit NCPDP Pharmacy/5010 X12 batch HIPAA-compliant transactions through MN–ITS (references to real-time apply only to production submissions, not to syntax testing).
ISA/IEA per file
For batch or real-time applications, MHCP processes only one Interchange ISA/IEA loop per file. If you send more than one Interchange ISA/IEA loop, MHCP will reject with a TA1:TA104-022 (Invalid Control Structure).
GS/GE per ISA/IEA
ST/SE per GS/GE
See Appendix B.1.1 Interchange and Application Control Structures of the Implementation Guides for additional information.
Use the following formats when naming files and submitting X12 Batch or NCPDP HIPAA-compliant transactions to MHCP.
Inbound files (837, 270, 278, 276, N12, NCPDP)
To send inbound files:
“Transaction ID” may be any of the following:
Example of a file following the suggested format above:
X12 RA (835s, 835Es and 835Cs)
MHCP uses the following filename formats:
The eligibility response is file-to-file transaction. MHCP uses the following filename format:
“INfilename” = the incoming file name in the 270 requests without an extension (.txt, .dat, .dat01, and so on)
Acknowledgements (TA1, 999, N12R)
MHCP uses the following filename format for TA1, 999 and N12R acknowledgments:
“INfilename” = the incoming file name without extension (.txt, .dat, .dat01, and so on)
“InTransactionID” = the “TransactionID” from the inbound file for which the Acknowledgements are generated
MHCP requires all trading partner batch submitters, including managed care organizations (MCOs), to test for syntax errors before submitting 5010 batch transactions. Upload all syntax test transactions manually using the Submit Transactions application in MN–ITS. MHCP will not respond to test files submitted through SFTP.
If you use a billing organization that submits batch transactions on your behalf, the billing organization must initiate the 5010 syntax testing for your batch files.
The MN–ITS test region allows batch submitters to test transactions for syntax errors in an environment similar to MN–ITS production. MHCP created one username and one password for all MN–ITS test account users.
Log in to the MN–ITS test region
To access the test region:
MHCP sends a response to your test region mailbox within 48 hours. After you receive an AcceptTestMsg.txt per transaction type, wait 48 hours before submitting in production.
Current X12/NCPDP batch submitters: MHCP created a test account for your NPI/UMPI. Follow the directions on the MN–ITS Test Region home page to log in to your test account (NCPDP testing is only for MCOs).
New batch submitters: You must first create your test account within the test region before logging in to submit test transactions. Follow the steps on the Test Region home page in MN–ITS to create your test account.
Avoid these common syntax testing errors:
After submitting your 5010 test transactions, check the 999, TA1 or Production Failed folders within the test region for results.
Review MCO Encounter Submissions from the Managed Care Organization provider home page for additional information about submitting 5010 transactions to MHCP. The following explains how to submit 5010 and NCPDP test transactions to MHCP.
MCO encounter claim test transactions
MCOs must follow the steps below to submit test transactions to MHCP:
Continue to review MCO Encounter Submissions for additional instructions and announcements.