The deadline for all HIPAA-covered entities to complete their upgrade to Version 5010 electronic standards ends June 30, and CMS reminded hospitals and other providers to follow three tips to avoid unnecessary claims rejections.
1. ZIP code. Hospitals must include a complete nine-digit ZIP code for the billing provider and service facility location. CMS said providers should work with vendors to make sure IT systems capture the full nine-digit code.
2. Billing provider address. Version 5010 transactions do not allow for the use of a P.O. Box address for either professional or institutional claim formats, so a physical address is needed for the billing provider address.
3. National Provider Identifier. Previously, hospitals and other providers were allowed to report an employer's identification number of Social Security number as a primary identifier for the billing provider. For Version 5010 claims, healthcare organizations are only allowed to report the NPI as a primary identifier.
For additional help with the transition to Version 5010, hospitals and other providers are encouraged to contact their Medicare Administrative Contractor, which work closely with clearinghouses, billing vendors and other healthcare entities.
1. ZIP code. Hospitals must include a complete nine-digit ZIP code for the billing provider and service facility location. CMS said providers should work with vendors to make sure IT systems capture the full nine-digit code.
2. Billing provider address. Version 5010 transactions do not allow for the use of a P.O. Box address for either professional or institutional claim formats, so a physical address is needed for the billing provider address.
3. National Provider Identifier. Previously, hospitals and other providers were allowed to report an employer's identification number of Social Security number as a primary identifier for the billing provider. For Version 5010 claims, healthcare organizations are only allowed to report the NPI as a primary identifier.
For additional help with the transition to Version 5010, hospitals and other providers are encouraged to contact their Medicare Administrative Contractor, which work closely with clearinghouses, billing vendors and other healthcare entities.
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CMS Will Not Enforce Version 5010 Through June
3 Issues to Monitor in the Upgrade to Version 5010