HIPAA 5010 troubleshooting tips

March 1, 2012


As HIPAA 5010 claims submissions come in, IBC has been identifying the most common reasons for claims rejections. Please review the following information carefully to avoid 5010 claims rejections:

  • Invalid Payer Code/NAIC in loop 2010BB, NM109: There is additional information being placed in this field along with the 5-position Payer Code/NAIC value. As stated in the HIPAA 5010 Companion Guides, only the 5-position Payer Code/NAIC value should be placed in NM109 (where NM101 = PR and NM108 = PI).

    Correct: NM1*PR*2*IBC TRADITIONAL*****PI*54704

    Incorrect: NM1*PR*2*IBC TRADITIONAL*****PI*54704<DIV>0001202000~

  • Invalid Claim Filing Indicator in loop 2000B, SBR09: In this loop and segment, the value "HM" is being listed as the Claim Filing Indicator. As stated in the HIPAA 5010 Companion Guides, IBC only accepts the following Claim Filing Indicators:

    BL for IBC/KHPE Products (including Select Advantage)

    MA or MB for Medicare Crossover Claims

    MC for Family Planning Claims only

  • Invalid CN1 segment: As stated in the HIPAA 5010 Implementation Guides, 5010 transactions containing the CN1 segment will be rejected as the CN1 segment is not HIPAA compliant. This may occur if 4010 transactions are converted to the 5010 format prior to being submitted to NaviNet.

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).

If you are not prepared to submit and accept HIPAA 5010-compliant transactions by March 31, 2012, you may be adversely affected by conversion activities initiated by IBC and/or your trading partners. We encourage you to continue working with your trading partners to ensure your preparedness and to avoid any negative outcomes during this transition.