The deadline for the Version 5010 upgrade was January 1, 2012, and the
enforcement discretion period for all HIPAA-covered entities to complete
their upgrade to the Version 5010 electronic standards ends on June 30,
2012. The Version 5010 transaction standards have different requirements
than those of Version 4010 and 4010A. There are a few things to keep in mind
for processing your Version 5010 claims, which should help avoid unnecessary rejections:
1. ZIP Code: You need to include a complete 9-digit ZIP code for the
billing provider and service facility location. You should work with your
vendor to make sure that your system captures the full 9-digit ZIP.
2. Billing Provider Address: You need to use a physical address for
your Billing Provider Address. Version 5010 does not allow for use of a PO
Box address for either professional or institutional claim formats. You can
still use a PO Box, however, as your address for payments and correspondence
from payers as long as you report this location as a pay-to address.
3. National Provider Identifier (NPI): You were previously allowed to
report an Employer’s Identification Number (Tax ID) or Social Security
Number (SSN) as a primary identifier for the billing provider. For Version
5010 claims, however, you are only allowed to report an NPI as a primary
identifier.
For additional help with your Version 5010 upgrade and Medicare claims, you
can contact your Medicare Administrative Contractor (MAC). The MACs work
closely with clearinghouses, billing vendors, and health care providers who
require assistance in submitting and receiving Version 5010 compliant
transactions. If you experience difficulty reaching a MAC, you should send a
message describing your issue to ProviderFeedback@cms.hhs.gov with “5010
Extension” in the subject line.
The Medicare Fee-For-Service group has created a fact sheet that provides
guidance to help providers troubleshoot some of the difficulties they may
experience with Version 5010 claims processing and links to each of the MAC
websites, including lists of the top 10 edits for Version 5010 claims.
FACT SHEET:
https://www.cms.gov/
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