As HIPAA 5010 claims
submissions come in, IBC has been identifying the most common reasons for
claims rejections. Please review the following information carefully to avoid
5010 claims rejections:
- Invalid Payer Code/NAIC in loop 2010BB, NM109: There
is additional information being placed in this field along with the 5-position
Payer Code/NAIC value. As stated in the HIPAA 5010 Companion Guides, only the
5-position Payer Code/NAIC value should be placed in NM109 (where NM101 = PR
and NM108 = PI).
Correct:
NM1*PR*2*IBC TRADITIONAL*****PI*54704
Incorrect:
NM1*PR*2*IBC TRADITIONAL*****PI*54704<DIV>0001202000~
- Invalid Claim Filing Indicator in loop 2000B, SBR09:
In this loop and segment, the value "HM" is being listed as the Claim
Filing Indicator. As stated in the HIPAA 5010 Companion Guides, IBC only
accepts the following Claim Filing Indicators:
BL
for IBC/KHPE Products (including Select Advantage)
MA
or MB for Medicare Crossover Claims
MC
for Family Planning Claims only
- Invalid CN1 segment: As stated in the HIPAA 5010
Implementation Guides, 5010 transactions containing the CN1 segment will be
rejected as the CN1 segment is not HIPAA compliant. This may occur if 4010
transactions are converted to the 5010 format prior to being submitted to
NaviNet.
HIPAA 5010 Companion Guides can be found in the EDI section of the IBC website.
If you have any questions concerning your HIPAA 5010-compliant transactions,
please contact your trading partner (clearinghouse/vendor).
If you are not prepared to submit and
accept HIPAA 5010-compliant transactions by March 31, 2012, you may be
adversely affected by conversion activities initiated by IBC and/or your
trading partners. We encourage you to continue working with your trading
partners to ensure your preparedness and to avoid any negative outcomes during
this transition.