2260 Apollo Way, Suite 103
Santa Rosa, CA  95407
Phone: (800) 763-8484

5010 Frequently Asked Questions

The following information is provided as on on-line reference. Please check back often as we will update our FAQ section with new questions and answers as necessary.

Q. We want to begin looking over the specs and implementation guides. Does ClaimRemedi have these available?

A. ClaimRemedi is utilizing the information available in the TR3s (implementation guides) that are published for all 5010 ANSI transactions. These guides are copyrighted and are available for purchase from WPC or ASC12. Details can be found and available through their website @ :
http://www.wpc-edi.com/content/view/817/1

Q. We send our data to other clearinghouses. They have a program that will allow us to send them all of our 5010 data in an XML format and they will convert those to valid ANSI 5010 formatted transactions on our behalf. They will do this for future ANSI versions as well. Do you have something like that?

A. ClaimRemedi is preparing its systems to accept and process Version 5010 in accordance with federal timelines and on track with meeting the deadline of January 1, 2012. We will have the ability to accept both 4010 and 5010 depending on Providers / Payers availability.

Q. Where can I find a list of changes from the 4010 to the 5010 for 837 and other ANSI transactions?

A. Please visit the CMS website for a complete side-by-side view of all ANSI transactions @: http://www.cms.gov/ElectronicBillingEDITrans/18_5010D0.asp

Q. What are the major 5010 changes to consider?
A. The following are the major changes you should consider:
  1. All providers MUST report NPI numbers for all providers
    See the “5010 NPI Requirements” link for specific details.
  2. Addresses for payers and providers will no longer allow P.O. Boxes
    Physical street addresses are the only acceptable form to report these.
  3. Patient Signature Source Code
    Even though this data element is currently required for all claims, the use of this data element has changed in HIPAA 5010 & is now only required when a signature was executed on the patient’s behalf.
  4. Number of DX Codes on a claim
    In preparation for the migration to ICD-10 diagnosis codes, the maximum number of DX codes was increased from 8 in 4010 to 12 in 5010. In addition, the Diagnosis Code is now required on all claims.
  5. Anesthesia Units/Minutes
    In 5010 Anesthesia services with procedure codes that do not have a specific time period defined in the description of the code must be reported using the value of MJ, which is minutes, reporting as units is no longer allowed.
  6. CTP Segment (NDC Drug Quantity) 2410 Loop
    In HIPAA 4010 the 2410 CTP segment for NDC Drug Quantity was Situational. In 5010, when submitting drug information, the NDC Drug Quantity is now required.
  7. Postal Codes
    The postal codes must be a 9 digit code for Billing & Service location addresses. Claimremedi will default 9998 in the last 4 bytes on the Billing Provider & Service Facility Location Addresses.
Q. How do I test transactions with ClaimRemedi?

A. Testing is a very important part of the transition to 5010. ClaimRemedi is here to help with testing your claims to ensure a seamless transition. ClaimRemedi’s Provider Testing is available in June, 2011. Please review our Provider Testing Guide.

Q. I can’t see or access the EDI Testing Tab?

A. Email 5010Testing@ClaimRemedi.com to request access for your Admin users.

Q. Where can I find my Billing Provider and Service Facility 9 Digit Zip code?

A. The USPS Zip Code Lookup page is available at http://ZIP4.usps.com/ZIP4/welcome.jsp

Q. What are the 9 Digit Zip Code requirements?
A. When reporting the ZIP code for U.S. addresses in the Billing Provider and Service Facility Location, the 9 Digit Zip Code must be provided.
  • For Dental Claims (837D) - Billing Provider (2010AA, N403) and Service Facility Location (2310C & 2420D, N403)
  • For Institutional Claims (837I) - Billing Provider (2010AA, N403) and Service Facility Location (2310E, N403)
  • For Professional Claims (837P) - Billing Provider (2010AA, N403) and Service Facility Location (2310C & 2420C, N403)
Q. Is it still ok to use my Billing Provider PO Box when submitting claims in 5010 Format?

A. As Payers transition to using the HIPAA 5010 standards the Billing Provider address on claims must be a physical location and Payers may reject a PO Box or Lock Box. Payers may enforce this change at any time as they prepare for and complete the transition to HIPAA 5010.

For many providers you will no longer be able to send a PO Box as the Billing Provider Address (Loop 2010AA). If needed, the PO Box can be included instead, in the Pay-To Provider Address (Loop 2010AB). This may also require an update to enrollment records with the Payer.

Q. We are currently sending Billing Provider Addresses with a PO Box or lock box what should we do?

A. Since it is not necessary to wait for your software vendor to transition to the HIPAA 5010 format or the January 1, 2012 compliance deadline, we recommend providers immediately develop and execute a transition plan to use a physical address. This transition plan should include contacting your Payers to verify requirements and updating your enrollment records as necessary. You may also need to work with your software vendor to change the addresses used on claims.

Q. What do I need to do to make sure my records / organization adheres to the new 5010 standard?
A. Although ClaimRemedi has implemented solutions to minimize the impact to your workflow, there are several additional tasks that we recommend you do to ensure the smoothest transition. These include:
  • Contact your software vendor for any required 5010 system releases, patches or updates
  • Test and Migrate to the 5010 version with ClaimRemedi as early as possible.
Q. Will ClaimRemedi continue to process 4010A1 transactions and 5010 transactions during the transition period, or will there be a cut-off date when transactions have to be in the new format to be processed?

A. Because transition dates vary with Payers, ClaimRemedi will convert files to 5010 or back to 4010 (Step Up / Step Down) as needed to accommodate the different timeframes of readiness among our payers and Trading Partners. Due to this capability ClaimRemedi will continue to accept the 4010A1 version after the January 1, 2012 compliance date.

Q. Will ClaimRemedi accept both the 4010A1 and 5010 versions from the same Customer?

A. Yes, ClaimRemedi supports Dual Submission.

Q. If I remain in 4010A1 format after 1/1/12 5010 deadline, do I still need to test with ClaimRemedi?

A. It is not necessary to perform any testing if you will remain in 4010A1 after the 1/1/12 deadline. ClaimRemedi will continue to Step Up your Claims to 5010 and step down your Remittances to 4010 until you are ready to transition to the 5010 format.


For further answers to questions not listed here, feel free to send your questions to: 5010Testing@ClaimRemedi.com