Version 5010 grace period is almost up

Just a reminder that the enforcement for the Version 5010 upgrade begins March 31.

CMS offers some advice on things to watch for (this is aimed at providers):

An Increase in Rejections or Denials of Claims

An increase in rejections or denials of claims may be an indication that there is not sufficient or correct data provided to meet Version 5010 standards. Partners, such as payers, also have a part in correcting this issue, since forwarding, converting, or formatting data can result in rejections or denials. Monitor your claims closely to determine the reasons for rejection or denial of claims and coordinate with payers to ensure that data is properly processed to avoid claim delays.

Issues with Non-Electronic Funds Transfer (non-EFT) Payments
Version 5010 includes changes to claims formatting, including a full nine-digit ZIP code and inclusion of provider billing address. Submitting claims with only a five-digit zip code will result in rejection. If your practice has not submitted the correct billing or mailing address as part of your Version 5010 claim, your non-Electronic Funds Transfer (non-EFT) payments or Explanation of Benefits (EOBs) information may be mailed to the wrong physical location. Make sure to coordinate with your payers to verify how they use enrollment information and process claims data, as this will also be affected by the mailing address on file. Being diligent in tracking your claims and remittances (EOBs) will help identify and address any issues that may arise.

Formatting Discrepancies with Partners
Your trading partners should also have upgraded to Version 5010; however, your organization may interpret the new standards differently than your external partners, which can result in rejected claims. You should coordinate with your payers and/or clearinghouse to determine any gaps or discrepancies in claims submissions. You and your partners should monitor claims that are automatically transferred between payers and address new response formats or data as claims are processed.


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