| BIN Number | Paper Claims | Format for Claims | Format for Recipient Cardholder ID Number | Name Verification | Drug File Converted to First Data Bank | Batch on Diskette and Tape Claims | Switch Connections | POS Format |
South Dakota Medicaid?s processor BIN number is 601574. This number has been assigned to the South Dakota Medicaid Program by the American National Standards Institute (ANSI). The BIN number must be included in all NCPDP transactions routed to the South Dakota Medicaid (SDMCD) POS system.
South Dakota medical assistance will continue to accept paper claims, but prefers that claims are sent via the POS.
Paper claims must be billed by using the NCPDP Universal Claim Form. Claims submitted via point-of-sale must follow NCPDP guidelines. Please visit with your software companies if you have questions.
Pharmacies may continue to send recipient cardholder identification numbers in the same format as in the past. Please notify your software developer that no change in recipient identification number format is required. Whatever format you are currently using for recipient identification numbers can be continued via point-of-sale.
Names submitted on claims must match with the name on the recipient cardholder identification number. Names that do not match with the recipient cardholder identification number will be denied. Please check your claim and data base to ensure an exact match. Example: Nicknames that do not match the identification cardholders name will also cause a denied claim.
We ask for your support during the file transition. FDB file is required to provide the necessary ProDUR alert information. The coverage status for more that 150,000 drugs must be converted individually to the new file. In addition, the new data file will identify NDC numbers that are obsolete or discontinued. This will assist in accurate rebate collections. We hope for a smooth transition as drug files are converted. Again, we ask for your support while this file conversion is implemented.
Batch claims on diskette and tape will continue to be accepted by SDMCD through September 1997. Beginning October 1, 1997 all claims must be submitted via POS or on paper. However, MIDCO and OmniSYS, and perhaps other vendors will have the capability of converting batches of claims into the NCPDP format and submitting them via POS. Information regarding MIDCO and OmniSYS is enclosed. Pharmacies that batch bill claims for nursing home residents may want to check with these or other companies.
Direct switch connections are being established with Timeshare Computer Systems and NDC. The Emdeon network is arranging to route services for its pharmacies through the Timeshare network.
The NDC and Timeshare (Emdeon)networks are capable of receiving data from providers/vendors at up to 9600 BPS. Those providers/vendors that handle a substantial number of claims may want to take this into consideration if contemplating new hardware (modems) in the future.
POS/ProDUR system will be compatible with most pharmacy computer systems, but some may need software changes. (Please pay special attention to the override process.)