HIPAA 5010

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Prepare for HIPAA 5010

HIPAA 5010 is a revised set of HIPAA standards that governs electronic transmission of administrative healthcare transactions. The standards affect the way electronic transactions, such as claim submission, remittance advice, claim status inquiries and eligibility inquiries, are formatted and transmitted.

While many of the changes will be unnoticeable, some may require an adjustment to your current practices. Below are a few changes that you should be aware of so you can make changes now or plan accordingly.

1. Every provider address in Dentrix must use a nine-digit ZIP code (ZIP+4).
2. For electronic claims, the Billing Provider name and Pay-To provider address (that appears in the Primary Dental Insurance window) will be sent in the claim and is where payors will send payment. The Rendering Provider name and Billing Provider address is also sent in the claim and reflects who performed the services and the location where services were performed.
3. The address for the Billing Provider can no longer be a P.O. box; it must be the physical address of the provider where services were rendered. However, the address for the Pay-To Provider can either be a P.O. box or physical address. The Pay-To Provider address should reflect where payors need to send payments (which may be different from the provider’s address where services were rendered).
4. Legacy IDs (such as Medicaid IDs, BCBS IDs and so forth) may no longer be sent in electronic claim submissions. Correct NPI numbers are required. Your front-office staff will need to contact insurance payors to verify that they have the correct NPI numbers in their provider tables.

Your practice must be fully compliant by March 31, 2012. Failure to make these changes could result in rejected claims or misdirected claim payments. For help implementing these changes, contact eServices support at 800-734-5561. Look for more information in coming months as we continue to provide helpful tips and product update information in preparation for HIPAA 5010.