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As HIPAA 5010 claims submissions come in, AmeriHealth has been identifying the
most common reasons for claims
rejections. Please carefully review the examples below to avoid 5010 claims
rejections.
Impacts 837P files only
When submitting Other Party Liability (OPL) claims, SBR09 not equal to ?P?, the
new 5010 AMT segment must be
submitted when AMT01 = ?EAF?.
Impacts both 837I and 837P files
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The description is required when submitting a non-specific procedure code. If
this information is not present on the claim, the claim will fail compliance.
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837I 2400.SV202-7
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837P 2400.SV201-7
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REF segments are only allowed in the following loops when an NPI is submitted
on the claim:
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2010AA Billing Provider Name
2010BB Payer Name
2310A Referring Provider
2310B Rendering Provider
2310C Service Facility
2420A Line Level Rendering
Provider
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2010BB Payer Name
2310A Attending Physician
2310B Operating Physician
2310C Other Operating Physician
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Note: If the subscriber is not the patient, please ensure that the
patient?s ID is submitted in 2010BA.NM109.
HIPAA 5010 Companion Guides can be found in the EDI section of the AmeriHealth
website. If you have any questions concerning your HIPAA 5010-compliant
transactions, please contact your trading partner (clearinghouse/vendor).
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