I'm 5010 compliant, but where are my checks?!

By Robyn O'Connell
09:30 AM
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With the 5010 deadline of 1/1/2012 fast approaching, many organizations are beginning to send out fully compliant 5010 claims to their payers and/or clearing houses. One of the big changes required in 5010 was that the billing provider addresses no longer can contain PO Box numbers.

Organizations have scrambled to validate the provider addresses, but in some cases, those addresses became the “mailing addresses” of record and the reimbursement checks started disappearing or took days or weeks to find their way to the bank!

[Could ICD-10 become the next mortgage crisis? Yes, and here's why.]

This checking is easy when you are sending claims to a direct payer, but if you are sending commercial claims through a clearinghouse, you may be dealing with different issue. It seems that the hybrid methodology that many clearinghouses used to send 5010 claims in a 4010 format may be to blame. Many did not use the new Pay to Address(Loop 2010AB) to map to the old Billing Provider Address, and for some payers that led to checks being directed to the main address of the organization instead of the bank lockbox or billing offices.

Other organizations are reporting issues with rejected claims because the new Billing Provider Address(Loop 2010AA) does not match what is in the enrollment record for the NPI or Legacy ID associated with the Billing Provider.

What are the steps I can take?

1. Refer to Companion Guides or talk with trading partners about the verification strategies for address fields.

2. Communicate with your clearinghouse on what steps it has taken on this issue.

3. If verification of addresses is an issue, validate your enrollment records or update.

[See also: ICD-10's day of reckoning -- the HIPAA 5010 compliance deadline. Related: ICD-10's ten-year reign of fear.]

4. Do not send new Pay to Provider and Billing Provider Addresses on non-validated payers for down-converted claims, if possible.

5. Buy lunch for your credentialing staff as a sign of appreciation when you have them update all enrollment records!

I know this is the final quarter and everyone is stretched thin, but these steps may be necessary to maintain your cash flow.

Robyn O'Connell is a senior healthcare consultant at Hayes Management Consulting. This article was originally published on Hayes Healthcare IT blog.