5010 - Your Vendor Can Not Solve The Problem

By Author: Erin Article
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Check on your address fields now -- before this becimes a major claims issue for your practice

Make sure that your address fields are 5010-form compliant or face claim rejections .Start double-checking your system's provider information and claim forms or you'll face scores of denied claims once CMS starts requiring the new HIPAA 5010 forms on Jan. 1.

Keep this in mind: Your claim will be denied if your 5010 claims list your practice's place of service as a P.O. box. Besides, if you rely on your vendor to do all of your 5010-readiness work for you, it's worse, because the vendor would be unable to make updates like this for you as they're in your system, not the vendor's data files.

Under the new 5010 standards, the place of service address (the doctor's practice office location) cannot be a P.O. box -- it is important that it is a street address. If it isn't a street address, the claim would get rejected. The vendor doesn't have control of what they call the provider master list -- the practice or billing company has to ensure that address is a street address.

NOTE: ...
... The "pay to" address can continue to be a P.O. box or lockbox. The problem is that some of the low-end systems have just one address field which serves as both the office address and pay to address, and if in the past they were always using a P.O. box, they can no longer do that.

Those practices who continue maintaining lockboxes with P.O. box addresses but who don't have the ability to fill in two different fields will either have to give up their lockboxes or use the lockbox address and face claim rejections. Alternately, they'll have to get a software update or upgrade so they can have two fields for the separate addresses.

Remember that you'll also need to ensure that the beneficiary's information on your claim is accurate as well. CMS will deny claims on which the beneficiary's name doesn't perfectly match how it's listed on his Medicare I.D. card when you begin using 5010.

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