HIPPA 5010 and changes in CMS 1500 CLAIM box 33

5010: Important Changes to Provider Information on Claims


With the implementation of 5010, there will be changes required for the way you send your electronic claim information. Understanding these changes and how they will affect your practice will prepare you for a smoother transition.

The Billing Provider Information sent in box 33 of a CMS 1500 form will need to be sent differently for 5010 electronic transactions.   The Billing Provider Information can no longer contain a PO Box or Lock Box and you must send the physical address of the practice.

If you use a PO Box or Lock Box to receive payment, it can still be sent on 5010 electronic transactions.  However, that information will need to be sent in the Pay-to Provider loop.


Here are common questions and answers for handling these changes to the electronic Billing Provider address and Pay-to Provider information:

Will I have to submit a physical address on a claim (street number and name) in the billing provider address?

    * Yes, all payers, including Medicare, will no longer allow a post office box or lock box address for the Billing Provider information (2010AA loop for ANSI claims).
    * Providers must submit a physical address (street number and name) for the billing provider address.
    * The Billing Provider zip code must be nine digits.
    * This rule applies to both professional and institutional claim formats.
    * Providers should work with their software vendors to ensure that the correct addresses are captured and sent in the correct locations for the 5010 implementation deadline.

Can I still have payments sent to a lock box or post office box?

    * Providers that have remittances delivered to a lock box or post office box address must send Pay-To Provider information (2010AB loop for ANSI claims).
    * The Pay-To Provider address is only needed if it is different than that of the Billing Provider.
    * This rule applies to both professional and institutional claim formats.
    * Providers should work with their software vendors to ensure that the post office box or lock box is sent in the correct location for the 5010 implementation deadline.