Reminder: ZIP Codes and Address Information for 5010A1

The information provided below is for claim files being sent in the version 5010A1 format. For more information about when you will be transitioning to this format, please contact your software vendor, billing service, or clearinghouse.

In the version 5010A1 format, a change has been made to include the full nine-digit ZIP Code for the Billing Provider (2010AA loop for ANSI claims). It will also be required for any Service Facility locations (2310C loop and 2420C loop for ANSI claims) if they are required to be sent. Providing all zeros in the 4-digit extension will cause front end rejections.

Quick Reference Full Nine-Digit ZIP Code Required:

2010AA Billing Provider
2310C Service Facility Claim Level
2420C Service Facility Line Level

Note: All other ZIP Codes may be sent in the five or nine-digit format.

The Billing Provider Address (2010AA loop for ANSI claims) will require a physical location address to be reported in 5010A1 claim files. PO Box and lockbox addresses cannot be reported as a Billing Provider Address. If you would like to send a P.O. box or lockbox address, it must be reported as a Pay-to Address (2010AB loop for ANSI claims). The Pay-To Provider address is only needed if it is different than the one being used for the Billing Provider. Providers should work with their software vendors to ensure that the correct addresses are captured and sent in the correct locations when they make the transition to sending the 5010A1 format.

Questions regarding these changes should be directed to your software vendor, billing service, or clearinghouse. Be sure to ask when you will be making the transition to the 5010A1 format for claim submission.

Post Date 05/09/11

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