HIPAA 5010 troubleshooting information

March 29, 2012

As HIPAA 5010 claims submissions come in, IBC 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 [

] 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. 837I 2400.SV202-7 837P 2400.SV201-7 REF segments are only allowed in the following loops when an NPI is submitted on the claim: [

837P HIPAA 5010 Transaction

837I HIPAA 5010 Transaction

2010AA Billing Provider Name

2010BB Payer Name

2310A Referring Provider

2310B Rendering Provider

2310C Service Facility

2420A Line Level Rendering Provider

2010BB Payer Name

2310A Attending Physician

2310B Operating Physician

2310C Other Operating Physician

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 IBC website. If you have any questions concerning your HIPAA 5010-compliant transactions, please contact your trading partner (clearinghouse/vendor).