It’s 2012 and HIPAA 5010 is officially here, yet many providers are still encountering difficulties as they transition their claims to be 5010 compliant. Recently, I wrote about the Top 5 potential roadblocks that could hold up reimbursements in 5010, which included changes to the fields used to report the billing provider address, ZIP code, drug information, anesthesia minutes and ambulance claims. To help providers continue with 5010 conversions, following is a list of six additional changes that may increase claims rejections if not addressed.
Billing Provider NPI. 5010 guidelines focus on creating uniform reporting of billing National Provider Identifiers (NPIs) to all payers. If the same NPI is not being consistently reported with all payers, the billing system needs to be analyzed to determine what NPI an office should be using for claims. Once a consistent NPI is developed, contact the payers’ provider relations offices to verify what steps to take in order to update the billing NPI with their organizations.
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