CMS and AAPC Offer Tips to Avoid 5010 Rejections

The Centers for Medicare & Medicaid Services (CMS) suggests in a May 24 news update ways to help avoid claims rejections when Version 5010 goes into effect. Providers and payers must be using Version 5010 to electronically file claims by July 1, a six-month extension past the original date of Jan. 1.

CMS cautions providers to be especially careful regarding the following information:

  1. ZIP Code: Include a complete 9-digit ZIP code for the billing provider and service facility location. Work with your vendor to assure your system captures the full 9-digit ZIP.
  2. Billing Provider Address: 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 as your address for payments and correspondence from payers, as long as you report this location as a pay-to address.
  3. National Provider Identifier (NPI): Report an NPI as a primary identifier. 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.

AAPC offers a special presentation June 19 at noon central time providing the following 5010 management information:

  • The checklist of last-minute items to ensure compliance
  • Common problems found with 5010 implementation, based on our recent 5010 implementation survey
  • Key steps to minimize claims, delayed payments, unresponsive payers, issues with Medicare administrative contractor (MAC), delivery problems, and denials.
  • Where to access tips, fact sheets, and other helpful resources from CMS to minimize disruptions to your practice

Cost is $29.95 and 1 CEU can be earned toward credential renewal. The presentation will be available on-demand immediately following the live broadcast.

For additional help with your Version 5010 upgrade and Medicare claims, contact your MAC. MACs work closely with clearinghouses, billing vendors, and providers who require assistance in submitting and receiving Version 5010 compliant transactions. If you experience difficulty reaching a MAC, CMS recommends sending a message describing your issue to with “5010 Extension” in the subject line.


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