Top 5010 Issues

Many physician practices have reported numerous problems across various areas of the United States stemming from the transition to Version 5010. The most frequently reported problems have involved:

  • Issues with practice management and/or billing systems that showed no problems during the testing phase with their MAC, but once the practice moved into production phase, found their claims being rejected
  • Issues with secondary payers
  • Rejections due to various address issues (pay-to address being stripped/lost from claims; pay to address can no longer be the same as billing address; no PO Box address)
  • Crosswalk NPI numbers not being recognized
  • “Lost” claims with Medicare Administrative Contractors (MACs)
  • Old submitter validation information not being transferred
  • Certain “not otherwise specified” claims being denied due to not having a description on the claim (CMS sent a notice of correction of this issue January 27, 2012)
  • Sporadic payment of re-submitted claims (with no explanation for rejections)
  • Protracted call hold times (most typically 1-2 hours) when attempting to contact Medicare Administrative Contractors (MACs) for further explanation of unpaid and rejected claims (a problem that dates as far back as November 2011)
  • Unsuccessful claims processing (with no reason cited for rejection) despite using a “submitter” that was approved after successful testing with CMS

Many providers report not having been paid by Medicare and TRICARE since as far back as November 2011 as a result of Version 5010 issues.  They also are not getting all the Carrier Reports back to confirm accepted and rejected status of the transmission of their claims.  Many are experiencing rejections that the Clearinghouse can not explain.  These issues must be monitored and steps taken to ensure that claims are getting processed through to the carriers as quickly as possible.

What have you experienced with the transition of 4010 to 5010 format?  We would love to hear your feedback.

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