5010 Information

Effective January 1, 2012, the X12 Version 5010 is required for all claims submitted electronically to payers.  Version 5010 is the new version of the X12 standards for Health Insurance Portability and Accountability Act (HIPAA) transactions.  Implementation of HIPAA Version 5010 may require changes to software, systems and perhaps procedures that you use for billing payers using Office Ally.

Office Ally is currently in the testing phase of 5010 and on our way to meeting the January 1, 2012 deadline.  We are working side-by-side with our payers as well as our customers to ensure a smooth transition for all.

Below you will find useful information to help prepare you for the mandated changes soon approaching.

CMS provides many resources to help you prepare for the U.S. health care industry's transitions.  For additional information on the X12 Version 5010 refer to their website at: http://www.cms.gov/ICD10/


Important Announcements:

New Ability for Providers to Register Physical Address
We now offer a new ability for Providers to register their physical address with Office Ally to meet the 5010 requirement for CMS1500 Box 33 Billing Provider Address.

With the implementation of the 5010 format, PO or Lock Box addresses are no longer allowed in the Billing Provider loop (CMS1500 Box 33).

For information on if this affects you and what you can do to be prepared click here.

5010 is coming - are you submitting 9 digit zip codes? 
With the implementation of 5010, many payers will start requiring the full 9 digit zip code for certain addresses/claims.  Prepare for this now by simply verifying that you are currently sending 9 digit zip codes for any Provider address on your claims.  For information on how to verify you are currently or begin sending 9 digit zip codes click here for further details.

  • If you do not know what the extra 4 digits of the zip code is for any address, you can look it up on the USPS website by going to www.usps.com and clicking on Look Up a Zip Code on the left hand side.  There you can enter the address and it will return the full 9 digit zip code.

Possible Enrollment Delays for Medicare
Office Ally has been notified that Medicare Administrative Contractors (MACs) received a Technical Direction Letter (TDL) 12035 from CMS that indicates providers should only be allowed to enroll for submitting 5010 claims (no more enrollments to submit 4010 claims) as of 11/1/2011. 

In addition to the MACs, the following payer(s) have also made the decision to enroll new providers starting 11/1/2011 for HIPAA 5010 only: 

          BCBS North Carolina (PayerID SB810)

For more information on the TDL and what this means to you click here.