Top 10 Version 5010 Submission Errors

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In Billing
July 15, 2011
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The Centers for Medicare & Medicaid Services (CMS) held its first National 5010 Testing Day on June 15, with interesting results. TrailBlazer and NHIC, Corp. recently posted testing outcomes in the form of a top 10 submission error list specific to each Medicare administrative contractor’s (MAC’s) jurisdiction.

TrailBlazer, A/B MAC for jurisdiction 4 (Colorado, New Mexico, Oklahoma, and Texas), posted on July 5 its top 10 errors for version 5010 claims. The list is broken down into two sections for Parts A and B of the Medicare program, and then broken down further in the Part B section to list the top errors for each of the four states in the jurisdiction.

The most common error for Colorado was “invalid information” in the billing provider’s postal/ZIP code. For the other states, claims were commonly rejected for a “relational field” error due to the billing provider’s submitter not being approved for electronic claim submissions on behalf of the billing provider. Other top errors mainly dealt with invalid information of some sort, such as service location, billing provider tax ID or National Provider Identifier (NPI), subscriber’s contract/member number, etc. Duplicate submission also made the list.

NHIC, Corp.’s top 10 list was all-inclusive, starting with the top 10 error and working down. The most common error to make the top 10 in jurisdiction 14 (Maine, Massachusetts, New Hampshire, Rhode Island, and Vermont) also was for claims rejected for a relational field error due to the billing provider’s submitter not being approved for electronic claim submission on behalf of the billing provider. Likewise, other common errors that made the list involved invalid entries for postal/ZIP codes, tax IDs, NPIs, and other such information.

Don’t let common errors like these delay your claims payment! All Health Insurance Portability and Accountability Act (HIPAA)-covered entities should be taking steps now to get ready, including conducting external testing to ensure timely compliance. The version 5010 compliance date is Jan. 1, 2012. The new standard is being implemented in two levels:

  • Level I requires covered entities to test throughout the year, and to schedule testing as early as possible, to ensure sufficient time for corrective actions and re-testing.
  • Level II requires covered entities to complete end-to-end testing with each of its trading partners, and be able to operate in production mode with the new versions of the standards.

The next National 5010 Testing Day is scheduled for Aug. 24. National 5010 Testing Days are an opportunity for trading partners to come together and test compliance efforts that are already underway with the added benefit of real-time help desk support and direct and immediate access to MACs. Note, however, that these CMS-sponsored testing days do not preclude trading partners from testing transactions immediately with their MAC.

Breaking News: On July 8, CMS published in the Federal Register the interim final rule “Administrative Simplification: Adoption of Operating Rules for Eligibility for a Health Plan and Health Care Claim Status Transactions” to fulfill Administrative Simplification provisions mandated in the Affordable Care Act. This interim final rule with comment period adopts operating rules for two HIPAA transactions: eligibility for a health plan and health care claim status. This rule also defines the term “operating rules” and explains the role of operating rules in relation to the adopted transaction standards.

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