How to Avoid Common Version 5010 Claims Rejections

Published 03/13/2023

There are a few things to keep in mind when processing your ASC X12 837 version 5010 claims, which should help avoid unnecessary rejections:

  • ZIP Code: You need to include a complete 9-digit ZIP code for the billing provider and service facility location. You should work with your vendor to make sure that your system captures the full 9-digit ZIP.
  • Billing Provider Address: You need to use a physical address for your Billing Provider Address. Version 5010 does not allow for use of a PO Box address for either professional or institutional claim formats. You can still use a PO Box, however, as your address for payments and correspondence from payers as long as you report this location as a pay-to address.
  • National Provider Identifier (NPI): You were previously allowed to report an Employer’s Identification Number (Tax ID) or Social Security Number (SSN) as a primary identifier for the billing provider. For v5010 claims, however, you are only allowed to report an NPI as a primary identifier.

For additional help with your v5010 upgrade and Medicare claims, you can contact your Medicare Contractor. They work closely with clearinghouses, billing vendors, and health care providers who require assistance in submitting and receiving v5010 compliant transactions.

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