What we are Hearing about ANSI 5010: Common Rejections

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Gavin Walker
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Joined: Wed Apr 04, 2007 10:11 pm
Location: Springfield, MO

What we are Hearing about ANSI 5010: Common Rejections

Post by Gavin Walker » Fri Jan 27, 2012 12:29 pm

The ANSI 5010 standards for electronic healthcare claims went into effect on January I, 2012. Payers – including Medicare, TRICARE and some state Medicaid plans – are currently rejecting claims that are not in the 5010 standard format. Rejections typically occur because of the fields or data elements listed below.

McKesson’s practice management products will produce 5010-compliant claims provided that that the appropriate data has been supplied on the claim by the billing entity.

Common 5010 Rejections
  • • 9-digit ZIP code for the billing provider and service facility location: The 9-digit ZIP code can be easily looked up on the US Postal Service web site. It must be populated on the 5010 claim. If the last four digits are not populated on the 5010 claim, the clearinghouse likely will put in four default numbers. However, we are hearing from RelayHealth (which is using 0000 as the default) that many payers are rejecting claims with a default 9-digit ZIP code. The best practice is to capture the 9-digit ZIP code in the practice management system (Medisoft Version 17 or Lytec 2011) so that the additional digits are populated correctly on the 5010 claim.
    • Pay To Address: PO boxes are no longer allowed in the practice/provider loops/segments. PO Boxes must be separately sent in the Pay-to fields.
    • Special Characters: Do not use #, :, ‘, - in any fields. The most common character is the # sign. Instead of using this for suite numbers or apartment numbers, spell out “number” or use “apt.” or “ste.”
    • NDC numbers: With 5010 NDC numbers are required on ALL injections. NDC numbers must be 11 characters long. A leading zero must be added if the NDC number is 9 or 10 digits in the segment. It must be in a 5-4-2 format.
Stay tuned for more information to come as the industry continues to adopt the 5010 standards.
Gavin Walker
Walker Tek Solutions, LLC

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