Home Page > Industry Regulations > HIPAA 5010: Understanding Two Important New Requirements

HIPAA 5010: Understanding Two Important New Requirements

It is not a secret that January 1, 2012 will usher in a huge change to healthcare. Once HIPAA Version 5010 is fully enacted throughout the industry, practices will need to ensure their claims are delivered to payers based on the new transaction standards—or risk losing proper reimbursement for services rendered. Although a majority of the necessary changes associated with HIPAA 5010 will be handled by technology vendors, a few major updates to claims submission must be handled directly by each medical practice in the nation. Specifically, practices will have to ensure they are prepared for the new billing provider address and zip code requirements.

As the deadline for 5010 looms near, more and more medical practices are beginning to review exactly what these two changes mean to their claims submission processes. Here is a clarification, plus some suggestions to help practices prepare:

  • Billing Provider Address: Once HIPAA 5010 is implemented with a payer, each medical practice must report a physical street address in the Provider Billing address field. Medical practices that wish to have payments delivered to a PO Box (or any address other than the Provider Billing address) can report that address in the Pay-To address field. While a PO Box address cannot be used as the practice’s street address, the PO Box may still be used for other claim addresses, such as a payer or patient address.
  • Nine-Digit Zip Codes: Once HIPAA 5010 is implemented, a nine-digit zip code must be reported in the practice’s Billing Provider and Service Facility Location address fields. You can continue to use a five-digit zip code for the practice’s Pay-To Address, the Subscriber, the Patient, the Payer and all other addresses on the claim. To be prepared, review the zip code values you currently have set up for your practice street and all service facility addresses to be sure they are valid nine-digit zip codes. If you are unsure what your nine-digit zip is, verify with the USPS at www.usps.com.

Although there are a number of changes that will occur with the transition, these two will impact most medical practices and cannot be handled exclusively by technology vendors. Don’t leave your revenue to chance – make sure your practice prepares for these changes long before HIPAA 5010 is enacted.

Have any other questions about what the transition to HIPAA 5010 means for your practice? Leave a question in the Submit an Idea area to the right or the comment box below and we will be sure to answer it in an upcoming blog post.