Medicaid Encounter Data System (MEDS)
Medicaid Encounter Data System (MEDS) is designed to collect, process, store, and report managed care service activities and prescription drug utilization for all Florida Medicaid capitated health care providers. MEDS also supports the risk model computations that set capitated payments for managed health care entities as defined in the Florida Medicaid Reform contracts.
The project was mandated by HB 3B during the Florida Legislature’s 2005 Special Session “B” and is in compliance with Title XIX of the Social Security Act, the Balanced Budget Act of 1997, 42 CFR 438, Chapter 409 and 641, Florida Statutes.
HIPAA 5010 and NCPDP D.0 Encounter Claims Submissions
Effective March 1, 2012 the Florida Medicaid Program is no longer accepting versions 4010 of X12 837 encounter claims and version 5.1 of NCPDP transactions. March 1, 2012 through June 30, 2012 is the period designated for health plans to complete software and business changes and finalize testing activities to transition to 5010 and D.0 formatting.
Pharmacy Encounters
Please refer to the “Encounters Testing” document located on the website for details about NCPDP testing:
Pharmacy Encounters Testing Companion Guide
X12 837 Encounter Claims
Please use the Ramp Manager to test X12 transactions against Florida specific processing rules. You will find instructions on the Florida Medicaid public portal.
Ramp Manager Information Sheet
Submit your 5010 encounter claims as a production file (with ‘P’ in the header), so the system will process the claim appropriately and return the response files. You will also have the opportunity to correct claims/service lines by voiding and replacing, or resubmitting. Please limit your submission to 1000 total claims. Keeping submission volumes to a manageable level will enable the health plan to review their processing results and take corrective action in a timely manner, as well as limit the extent of any unforeseen issues. By July 1, 2012, all health plans will be expected to have completed readiness activities and resume submission of encounter claims according to contract requirements.
Submission and Enforcement Timeline
Completeness, Accuracy and Timeliness measures will be applied to encounter claims according to the following timelines.
- X12 encounter claims with health plan paid dates through 5/31/2012 must be submitted by 8/1/2012.
- X12 encounter claims with health plan paid dates of 6/1/2012 and after are to be submitted on the normal routine (due within 60 days following the end of the month in which the payment was made).
- Pharmacy encounter claims with dates of service through 6/30/2012 must be submitted by 7/15/2012.
837 Companion Guides Clarifications
- The recently published 837 Companion Guides specify: ‘For encounter claims, MCO is the primary and secondary payer.’ The guides are being updated with a clarification. The health plan should always be reported as one of the payers. When there is another payer, third party liability (TPL), the TPL is primary and the health plan is secondary. When there is no TPL the health plan is primary.
- Values portrayed in the CN101 segment are not restrictive. All values associated with the CN101 in the 5010 Implementation Guides are permissible.
EDI Contact Information
For technical questions and/or clarifications of the 5010 encounter Companion Guides, please contact the fiscal agent EDI Team. The phone number is 1-866-586-0961.
Current Information
MEDS Archive
Reports and Presentations
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Email your comments and suggestions on the Medicaid Encounter Data System to:
medsmailbox@ahca.myflorida.com
