Why So Much N22226? More 5010 Guidance

The Centers for Medicare & Medicaid Services (CMS) has reissued communication to clarify Medicare’s capability to cross over version 4010A1 and National Council for Prescription Drug Programs (NCPDP) version 5.1 batch claims to the supplemental payers that have cut over to exclusive receipt of version 5010 837 claim formats or NCPDP D.0 batch claim formats. Also in the revised communication, CMS downplays the impact on providers permitted to submit claims using the CMS 1500 or UB04 hardcopy (paper) formats.

An MLN Matters® Special Edition article, revised Jan. 17, entitled “Additional Health Insurance Portability and Accountability Act (HIPAA) 837 5010 Transitional Changes and Further Modifications to the Coordination of Benefits Agreement (COBA) National Crossover Process,” addresses a perceived concern that exists among the provider community.

According to CMS, providers are confused whether billing of hardcopy CMS 1500 or UB04 claims or HIPAA version 4010A1 or NCPDP version 5.1 batch claims will result in Medicare being unable to cross over those claims to COBA supplemental payers that have made a 100 percent conversion to the new electronic transaction formats. CMS says this is not the case.

Billing vendors and physician/practitioner, provider, or supplier offices that bill Medicare will not continue to receive error code N22226 4010A1 production claim received, but the COBA trading partner is not accepting 4010A1 production claims for every claim billed to Medicare using a hardcopy claim format (CMS-1500 or UB-04) or version 4010A1 or NCPDP 5.1 batch format.

During the version 5010 90-day non-enforcement period (Jan. 1 through March 31), Medicare has the systematic capability to perform up- or down-version conversion of incoming claim formats (i.e., convert incoming hardcopy formats to HIPAA-equivalent claim formats or convert incoming version 4010A1 claim formats to 5010 formats and vice versa).

Physicians/practitioners, providers, and suppliers with authorization under the Administrative Simplification Compliance Act (ASCA) to submit claims using a hardcopy format should know that Medicare has the systematic capability to convert keyed claims into outbound-compliant HIPAA 837 claim formats for crossover claim transmission purposes. This is true at all times, CMS says, not just during the 90-day non-enforcement period.

With the exception of hardcopy claims, however, this practice will discontinue at the conclusion of the 90-day non-enforcement period.


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6 Responses to “Why So Much N22226? More 5010 Guidance”

  1. Sabrina says:

    Did anyone else have any rejections or a million phone calls after switching to 5010. we received phone calls and denials for not having our PO box on the hcfa. they would call and verify that our physicial address was on the claim but our po box is on file for payment. what should they use….or they would just flat out deny our claims….any other people having these issues???? Thanks and have a great day!

  2. Sheree says:

    Here you go

  3. Sheree says:

    Here is some helpful information

  4. Sheree says:

    Here you go.

  5. Sabrina says:

    got nothing….did you have a link?

  6. Patricia says:

    5010 CMS 999 Response is going backwards. If you have an error the whole entire batch fails, which prompts a call to CMS, because who can read the raw Data? 45 minutes later, you are still on the phone with CMS waiting for level 2 to provide an answer. Then if you get your 999 to accept, it stills takes 12 to 24 hours to get your 277 confirming you batch has been accepted. We don’t need all 1000 claims back just the notification if we have a rejected claim and what it is!! Gone are the simplified days of 4010, I abosolutely hate billing to CMS beacause it nows takes more time than ever before

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