Avoid 5010 Rejections With CMS’ Advice

If you are worried about potential 5010 rejections when Version 5010 goes into effect, here’s some help by Centers for Medicare & Medicaid Services (CMS) to ensure you stay clear of them. Providers and payers will need to start using Version 5010 to electronically file claims by July 1.

CMS says that providers should be especially careful regarding the following information when Version 5010 goes into effect:

• 1. Nine digit ZIP Code: Be sure to add the complete nine-digit ZIP code for the billing provider and service facility location. Contact your local postal system or visit www.usps.com to get the 9-digit zip code.


• 2. Provide Address Requirement: Version 5010 requires the submission of physical address for your billing provider address and will not accept a PO box address for either professional or institutional claim formats. However, if you must report a post office box or lock box address for payment and correspondence for a payer other than Medicare, it can done as the Pay To address.


• 3. National Provider Identifier (NPI): You should report an NPI as a primary identifier now as against the previous system when reporting an employer’s identification number (Tax ID) or Social Security Number (SSN) as a primary identifier was allowed.


• 4. 4010/5010 differences: You can compare the old and new formats on the CMS Web site. http://www.cms.gov/ElectronicBillingEDITrans/18_5010D0.asp



Contact your Medicare administrative contractor (MAC) for any help regarding upgrade to Version 5010 or send your problem to ProviderFeedback@cms.hhs.gov with “5010 Extension” in the subject line.