HIPAA 5010

Highmark has identified a number of common coding errors for 837 claim transactions submitted using the Version 005010 format. These errors have resulted in rejections on the 277 Claim Acknowledgment (277CA) Transaction and delays in processing provider claims. Trading partners and software vendors are encouraged to review this list to avoid processing delays with their 005010-formatted claim transactions.

Listed below are the common coding errors. This list will be updated if additional coding errors are identified.

Post Date	Field/Edit	Error Description
May 16, 2011	Nine-digit ZIP codes	Providers must provide a full nine-digit ZIP code for billing provider and service facility locations on all claim submissions. When the full nine-digit ZIP code is required, spaces or zeroes are not valid in the last four digits of the ZIP code.
May 16, 2011	Reporting Anesthesia Services	Providers need to submit both the anesthesia code at the line level and the corresponding surgical code at the claim level for any claim where the anesthesia code is a 'Not Otherwise Specified' or 'Not Otherwise Classified' Code. If the claim level surgical code is missing, the claim will reject.
May 16, 2011	Billing Provider Address	Highmark will reject electronic claims containing a P.O. Box or “lockbox” as the billing provider address. The billing provider address must be a physical address. Highmark uses the mailing address we have on file for any mailings, not the address that is submitted on the claim.
May 16, 2011	Billing Provider Taxonomy Code	When the Billing Provider’s National Provider Identifier (NPI) is associated with more than one Highmark Contracted Specialty, the Provider Taxonomy Code correlating to the contracted specialty must be submitted in addition to the NPI.
May 16, 2011	Coding for NOC and NOS procedure codes	If a provider reports a Not Otherwise Classified (NOC) or Not Otherwise Specified (NOS) procedure code on a claim, a description of the service must also be reported on that claim line. Claims submitted with NOC or NOS codes that do not have a description at the line level are rejected. Note: Reporting a description with NOC or NOS procedure codes is not a new requirement for 005010, but the location for where the description is reported on the 837 Claim is different for 005010. Be sure to check with your software vendor to ensure the description is reported in the correct location.
May 16, 2011	Facility Admission Date Required	Providers must always report the beginning date of the episode of home health care on every claim for home health services. NOTE: This error is not specific to 005010, but is included here to make the reader aware of it.
May 16, 2011	Reporting RUG Assessment Date on SNF Claims	Providers must report the RUG Assessment Date using Occurrence Code 50 and the corresponding Occurrence Date. With this change, in Version 005010, revenue code 0022 no longer requires a Service Date on the line.

Trading partners are also advised to be sure they are using the approved version (i.e., base or Errata where applicable) for claim, remittance, and acknowledgement transactions.

Trading Partners and software vendors may also want to refer back to a Highmark Special Bulletin issued in April 2010 that contained additional information on changes in support of the 005010 mandate. This Bulletin can be found on the 5010 Library on Highmark's Provider Resource Center under the HIPAA section.

Have Questions?
Questions specific to the Version 005010 authorization process or electronic claim transactions can be addressed to Blue Shield’s EDI Operations department at (800) 992-0246.