What we are hearing about ANSI 5010: Common Rejections

The ANSI 5010 standards for electronic healthcare claims went into effect on January 1, 2012. Payers – including Medicare, TRICARE and some state Medicaid plans – are currently rejecting claims that are not in the 5010 standard format. Rejections typically occur because of the fields or data elements listed below.

**To help prevent 5010 rejections, first things first, make sure your practice has the most up to date version of 5010 compliant software (i.e. Lytec 2011, Lytec MD, SuiteMed).

Common 5010 Rejections

1. 9-digit ZIP code

for the billing provider and service facility location: The 9-digit ZIP code can be easily looked up on the US Postal Service web site. It must be populated on the 5010 claim. If the last four digits are not populated on the 5010 claim, the clearinghouse likely will put in four default numbers. The best practice is to capture the 9-digit ZIP code in the practice management system so that the additional digits are populated correctly on the 5010 claim.

2. Pay to Address: PO boxes no longer allowed in the practice/provider loops/segments. PO Boxes must be separately sent in the Pay-to fields.
3. Special Characters: Do not use #, :, ‘, – in any fields. The most common character is the # sign. Instead of using this for suite numbers or apartment numbers, spell out “number” or use “apt.” or “ste.”
4. NDC numbers: With 5010, NDC numbers are required on ALL injections. NDC numbers must be 11 characters long. A leading zero must be added if the NDC number is 9 or 10 digits in the segment. It must be in a 5-4-2 format.

Stay tuned for more information to come as the industry continues to adopt the 5010 standards.