HIPAA 5010 - What changes in CMS 1500 - what to do Medical billing company

5010 Tip Of The Week – Billing Provider Address

Did you know, with 5010, the Billing Provider Address you use on claims must be a physical address?  Once 5010 is implemented, you can no longer use PO Box and lock box addresses as a billing provider address.  This rule applies to both professional and institutional claim formats. However, you can still use a PO Box or lock box address as your location for payments and correspondence from payers as long as you report this location as a pay-to address. The pay-to- provider address is only needed if it is different than that of the billing provider. Work with your software vendor to ensure the correct addresses are captured and inserted in the necessary locations on your claim submission.

5010 Tip Of The Week – Nine Digit Zip Codes

Did you know, with 5010, providers must submit a full 9-digit ZIP code when reporting billing provider and service facility locations? An easy way to determine the 4-digit extension to your standard ZIP code is to look it up on the U.S. Postal Service’s ZIP Code Lookup Tool, which can be accessed through the following link http://ZIP4.usps.com/ZIP4/welcome.jsp. Work with your software vendors to ensure they can capture the full nine digits for the billing provider and service facility addresses. To help our providers, we will default the last 4 bytes of the billing provider and service facility ZIP codes to ‘9998’ if received as blank to prevent claims from being rejected

5010 Tip Of The Week – Older Claim Formats

Did you know, after the 5010 transition on January 1, Clearing house will continue to support claims sent in older formats, such as ANSI 4010A1, NSF, CMS 1500 and CMS UB-04 print image formats, as well as the new 5010 format?

We know not all clients and practice management software vendors will be ready to use the new 5010 format.  To support our clients and ensure their payments aren’t delayed, we will use our conversion process to translate any format you send us into a 5010-compliant format. In addition, some payers will not be ready to accept the 5010 format. We will identify and track these payers, so we can convert your 5010 files back into the format they need to process your claim.