11.01.2011

5010 - P O Box Rule

Comes January 1st 2012 all physicians, other health care professionals, payers, and clearinghouses that submit HIPAA transactions will be required to use only the 5010 transactions as of the deadline. If physicians are not ready, they risk claim rejections and interrupted cash flow.

Historically whenever there’s been a change to the claims submission formats or algorithms, we have seen vendors bending their rules to accommodate the physician offices. The main goal has always been to accommodate providers in such as way that they feel the minimal changes. I am not implying that providers do not like to change their submission methods; they do not have a dedicated full fledge IT staff so this practice is understandable. But this time there are some changes which are part of the 5010 that may be out of the hands of your vendor.

In Version 5010, practices can no longer use a P.O. Box as the primary billing address. Your claim will be denied / rejected if your 5010 claims list your practice's address as a P.O. Box.

If you wish to have payments delivered to a PO Box or lockbox (or any address other than the Billing address) you can report that address in the Pay-To address field. While a PO Box address cannot be used as the practice’s street address, the PO Box may still be used for other claim addresses (payer or patient address).

Technical Solution: Technically a script can be created which would “swipe” the P.O. Box address with a street address by looking at the “master list” but the challenge is that if your vendor has such list containing two addresses.

Make sure to confirm with your vendor or billing provider if they have a solution in place or if there is anything you may have to do. The deadline is 1/1/2012!

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