Secure Site Log In

Why Register?

  • Secure 24/7 access
  • Submit claims electronically
  • Get claim payment information through ERA/EFT
  • Learn about important Aetna announcements

5010/NCPDP D.0 Overview for Pharmacies

Aetna is taking steps to prepare for a change in the standard way pharmacy claims must be transmitted to us. This change is being initiated by the National Council for Prescription Drug Programs (NCPDP). Telecommunications Standard Version D.0 is an updated version of the Health Insurance Portability and Accountability Act (HIPAA) standard for pharmacy claims transactions. It is an online, real-time conversation of a request from the pharmacy to the health plan AND a response from the health plan to the pharmacy.

NCPDP is the pharmacy component of the larger industry 5010 upgrade. HIPAA X12 Version 5010 is a new set of standards that regulate the electronic transmission of specific healthcare transactions, including eligibility, claim status, referrals, claims, and remittances.

Covered entities, including pharmacies, are required to conform to HIPAA 5010 standards and upgrade to NCPDP D.0 in order to support current pharmacy service transactions.

Because Aetna recently contracted with CVS Caremark to perform certain pharmacy benefit management services on Aetna's behalf, Aetna will work in collaboration with CVS Caremark to ensure a smooth transition to NCPDP D.0.

Important Dates:
  • January 1, 2011, Aetna, in collaboration with CVS Caremark, began external testing to ensure pharmacies within our network can send and receive compliant transactions.
  • Until December 31, 2011, the final rule allows transactions use of either the previous version 4010A1, or the new version 5010.
  • January 1, 2012, Aetna plans to discontinue use of the previous ASC X12 version 4010A1. This is the compliance date required by law for use of the 5010 version of the X12 standards and the NCPDP D.0.

Pharmacist-directed Frequently Asked Questions