Dec 1st 2011 
Written by: Nicole Statley
The 5010 transition is complex and each payer is of course adding their own little twist to it. Without a doubt, most providers have by now heard of the ANSI 5010 transition that will be mandated 3/31/12. What a lot of providers do not know is how it will affect their claims.
A lot of offices have been asking technical support what they need to be doing to get ready. At this point, there is not a lot to be done except to educate yourself on what new information will be required. MedWorxs is making the necessary changes to the program to allow the new fields to be transmitted but what we cannot predict is which of those fields will now be required by each payer.
It is the providers job to know what is required for billing but we will be a support system for this transition to help you know how to get the information to go out on your claims.
Things could get a little crazy as more payers switch over to 5010 and bugs are worked out, so please be patient.
Here are some of the top issues that we have seen so far with 5010:
1. Billing Provider missing 9 digit zip code - MedWorxs has already researched everyone’s 9 digit zip code and added it to EDI.
2. Billing Provider PO Box Address is not allowed - In 5010, a PO Box is not allowed in the billing loop. A PO Box is allowed in the “Pay to” address. This has been addressed for any providers that had a PO Box as their physical address in EDI.
3. Drug Quantity and Unit of Measure required for NDC Drug Code - The use of NDC drug codes is not new, but in 5010 the drug code must be accompanied by Quantity and Unit of Measure.
4. Outpatient-Institutional Claims require Patient Reason for Visit#1 - In addition to the Principal Diagnosis, Outpatient-Institutional claims in 5010 require at least 1 Patient Reason for Visit Diagnosis Code.
This list obviously does not cover all of the new requirements but it gives you a glimpse into what we may encounter as more payers switch to 5010. Our support team is ready and willing to help in any way we can!
About the author
Nicole began working with MedWorxs in 2007. Started her career in MedWorxs Billing Services then transitioned to Electronic Data Interchange Support. She now helps our customers with their EDI and Technical support issues. Nicole loves helping people and her tenacious nature drives her to hunt down the answer to complex and sometimes elusive EDI issues.
