5010: Important Changes to Provider Information on Claims

With the implementation of 5010, there will be changes required for the way you send your electronic claim information. Understanding these changes and how they will affect your practice will prepare you for a smoother transition.

The billing provider information sent in box 33 of a CMS 1500 form will need to be sent differently for 5010 electronic transactions. The billing provider information can no longer contain a PO box or lock box and you must send the physical address of the practice.

If you use a PO box or lock box to receive payment, it can still be sent on 5010 electronic transactions. However, that information will need to be sent in the pay-to provider loop.

Here are common questions and answers for handling these changes to the electronic billing provider address and pay-to provider information:

Will I have to submit a physical address on a claim (street number and name) in the billing provider address?

Yes.  The Billing Provider Address reported must be a physical address.  PO Box and lock box addresses cannot be reported as a Billing Provider Address once 5010 is implemented.  This rule applies to both professional and institutional claim formats.  Providers should work with their software vendors to ensure that the correct addresses are captured and sent in the correct locations for the 5010 implementation deadline.

Can I still have payments sent to a lock box or post office box?

Yes.  If you use a PO Box or lock box address as your location for payments and correspondence from payers, you can continue to use this approach, however; you must report this location as a Pay-to Address. (2010AB loop for ANSI claims).  The Pay-To Provider address is only needed if it is different than that of the Billing Provider and providers should work with their software vendors to ensure that the correct addresses are captured and sent in the correct locations for the 5010 implementation deadline.

We have an FAQ section on our 5010 web page that will be updated often. Please remember to check back often at www.gatewayedi.com/5010/faq.

If you any questions about these changes or others, please email our Industry Initiatives department at industryinfo@gatewayedi.com.

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