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.
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Loading ...- Tags: 5010, HIPAA, Ken Bradley
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8 Responses for "HIPAA 5010: Understanding Two Important New Requirements"
in case of our technology is not ready for 5010, can a clearing house convert our 4010 claims to 5010 claims after Dec 31,2011
Hello Megha. The answer to your questions, is yes, as Navicure will be able to convert client’s claims from 4010 into 5010 after the implementation date. I’ll have someone from our 5010 team follow up with you in more detail directly. Thanks for your question.
Is it true that we will no longer be able to use a facility as a referring provider whenever 5010 goes into effect? Currently we use individual physicians and facilities as referring providers for Medicaid and such.
Yes, according to the 5010 specification, only a referring provider name (“person”) can be submitted.
What address do we need to list as the billing provider adddres? a correspondence/mailing address, an office location address, etc. Several of my groups have multiple locations where patients are seen and I am not sure how to handle billing provider address in this situation. Do we just choose one of our physical locations and use that or does this loop need to be changed depending on which of the group’s locations the patient was seen at?
Good questions. The 5010 specification itself says that the claim must always contain a physical street address to identify the organization requesting payment for health care services provided. In 5010 it is not permitted that this physical street be a PO BOX address. In ANSI, this is the practice street address, Loop 2010AA. If the practice has a “mailing”, “lock-box” or “pay-to” address, which is different from the physical street location and/or is a PO BOX, then this address is reported in addition to the physical street address, and in ANSI, this would be the “pay-to” address, Loop 2010AB. As long as claims are submitted with no PO BOX in the practice’s physical street address field, the claim meets 5010 requirements.
Which address you want to report as your physical street address depends in large part how you have entered information on your 1099, 855, and other enrollment forms with the IRS and payers. Remember that this address is frequently used by payers to cross-reference “whom to pay”. This address can be any address you want to use as your organization’s street address, and it can be different from where services where actually rendered or performed.
The rule is that if the address where services were actually rendered is different from the address you report as your practice street address, then you would send separate service facility information (on the HCFA form, this is box 32 and in ANSI this information could be sent in Loop 2310C or in Loop 2420C).
If you have a Central Billing Office (CBO), you might want to report your practice street address as the CBO address and report where services were rendered from your facilities as service facility information (HCFA 1500 Box 32/ANSI Loop 2310C or 2420C). If each of your facilities operate somewhat independently or separately for billing purposes, then you may want to report the facility’s address as the practice physical street address, which then, in this case, you would not need to report separate service facility because you are already reporting as the practice street address.
Regardless of which address you report as your physical street address, please make sure to let any payer you enroll with of any changes you make in what address you report – just in case they need to cross-reference the claim information with the address information they have in their system.
Can you direct me to the source 5010 specification that says what is allowed as the billers address? For example could it be the address of the business office for the group but not where the services were provided? If so I need to see from CMS or whomever that this is allowed.
We have a couple of items to clarify to help answer your question and will reach out to you via the email address you provided. Thanks!
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