US · guidance
CMS Pub. 100-04, ch. 27, § 80.9
Health Insurance Portability and Accountability Act (HIPAA)
5010 and National Council for Prescription Drug Programs (NCPDP)
D.0 Crossover Requirements
(Rev. 4009, Issued: 03-23-18, Effective: 04-23-18, Implementation: 04-23-18)
Effective January 5, 2009, the BCRC created a new 1-byte “5010 Test/Production
Indicator” and a new 1-byte “NCPDP D.0 Test/Production Indicator” on the COBA
Insurance File [COIF] (valid values= “N”—not applicable or not ready as yet; “T”—test;
“P”—production).
The CWF maintainer shall 1) create these new fields, along with 1-byte file displacement,
within its version of the COIF; and 2) accept and process these new fields when the
BCRC transmits them as part of its regular COIF updates. If the BCRC transmits a value
other than T, P, or N within the newly designated fields, CWF shall ignore the value.
In addition, the CWF maintainer shall add a new “5010 Test/Production Indicator” and an
“NCPDP D.0 Test/Production Indicator” to the BOI reply trailer (29) format.
The CWF shall not post crossover disposition indicators in association with claims whose
5010 and NCPDP D.0 indicators are “N” or “T.” (Refer to §80.5 of this chapter for more
information regarding claims crossover disposition indicators.)
History
(Rev. 4009, Issued: 03-23-18, Effective: 04-23-18, Implementation: 04-23-18)
Provenance
- Source
- cms.gov
- Retrieved
- 2026-08-25
- Edition
- iom-2026-08-25
- Content hash
3add5291199ba0583b0d497aa05140e9ad7a3badf2a4b2ea5707d393c135bf81
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