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5010 FAQs

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Since the implementation of 5010 on January 1, Midlands Choice has been asked many questions concerning claims submission.  Here are the answers to many of those frequently asked questions to help you with the changes.

Question:   Didn’t CMS change the required 5010 compliance date to March 31? 

Answer:  The Centers for Medicare and Medicaid Services announced that it would not seek enforcement action against any non-compliant entity until March 31.  However, the required compliant date remains January 1, 2012.

Question:  Because this is an EDI change, I don't need to change how I bill my paper claims, do I?

Answer:  A claim that leaves your office on paper will become an electronic claim at some point on its journey to the payer.  Therefore paper claims must also comply with the rules of 5010.  Please review the National Uniform Claims Committee's most recent manual for instructions on the completion of paper claims.

Question: If I am submitting a paper claim, is it necessary for me to include 9 digit zip codes in the billing and facility address fields?

Answer:  Yes.  Midlands Choice employees are correcting claims that come in with 5 digit zip codes to the appropriate 9 digit zip code.  However, effective April 1, 2012 Midlands Choice will begin to return claims that do not have 9 digit zip codes in the required fields to the providers.  This is a requirement of 5010 and the claim must be a compliant document in order for it to be delivered to the payer.

Question:  In order to comply with the mandate that billing addresses must be physical addresses, can I just put my practice address in CMS-1500 box 33?

Answer:  If your practice address is set up to receive mail should claim payments be submitted to that address, then yes.  Just as paper claims become electronic claims on their path to the payer, sometimes electronic claims are converted to paper if they cannot be submitted successfully via EDI.  When this occurs, "remit to" information is lost (since this field is not on the paper CMS-1500 form) and payers only receive the information you have supplied in the billing address field.  If you cannot receive mail at your practice address, then it may not be the appropriate physical address to use and you will need to identify an alternative.

Question:  Does Midlands Choice have any advice for me to make sure the 5010 requirements do not cause issues with where my claim payments are sent?

We recommend:

  • Submit as many claims as possible electronically and include an address in the "remit to" field; the "remit to" address can be a PO Box.
  • Elect Electronic Funds Transfer (EFT) payment with payers who administer benefits for a high volume of your clients to reduce your reliance on paper checks.  Click here for a list of Midlands Choice payers who offer EFT.
  • Finally, rethink using your practice address as your billing address for those claims that cannot be submitted electronically, or are being sent to payers that do not accept EDI claims or do not offer EFT.  Instead, work with your central billing office to establish a physical location where payments can be accepted, notify Midlands Choice and all other vendors of this address, and begin submitting that address rather than your physical practice address.