What is HIPAA 5010?
HIPAA 5010 is the next generation of standards for all HIPAA-compliant electronic transaction
activities used for exchanging information with insurance companies. What this means is, if
you submit electronic claims, the methods used must comply with HIPAA 5010. These changes
are mostly technical and cover two main areas: preparation for the ICD-10 Codes,
and streamlining reimbursements.
When does HIPAA 5010 become effective?
5010 formats were originally slated to replace the existing ones by January 1, 2012. Actual enforcement of
non-compliance has been pushed back several times already, and we recommend checking the
official government resources to find out when HIPAA 5010 is actually being enforced.
Can I still use the current CMS-1500 or UB-04 forms for paper claims?
Yes, you may still use the CMS-1500 or UB-04 paper claim forms to submit to insurance
companies. ClientTracker uses the CMS-1500 form (now caled simply "the 1500") exclusively.
- If you submit claims to Medicare, you must file elecronically and follow their unique rules
HELP! I submit claims electronically. What do I have to do?
Check with both your software vendor and clearing house to insure they are 5010 compliant.
They should already be set up for this. ClientTracker is --
see below for more info.
1. Facility Location (Box 32) and Billing Provider (Box 33) must have:
2. Billing Provider NPI, Box 33
- 9-digit ZIP Codes
- A physical address. You can no longer use a P.O. Box or Lock Box on the form. Some
clearing houses may have a workaround for this. If you work with Office Ally,
check their announcement
- Providers will be required to use the same billing NPI across all insurance payers.
While NPI consistency is a key component of 5010, it is at the payer's discretion to enforce
it. There is no regulation regarding the use of NPIs.
- A billing NPI is most commonly for an organization or a corporation.
- Individual NPIs will only be allowed when services were performed by, and will be
paid to, an independent, non-incorporated individual.
ClientTracker Can Help You Be 5010 Compliant
ClientTracker is fully compliant and ready to save you time dealing with 5010. Our
program submits an e-billing batch quickly and efficiently using a "print image" format.
This format is compatible with most clearing houses.
- ClientTracker is set up for 9-digit ZIP Codes, including printing or submitting electronically
- ClientTracker has a built-in ZIP+4 lookup that opens your browser in a handy
second window, and goes directly to your favorite ZIP+4 lookup web site
- ClientTracker has a flexible interface for billing with the proper NPI for your situation
- ClientTracker makes it easy to bill electronically and comply with this important new
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