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Important v5010 Reminders for Electronic Claim Submitters

March 16, 2012

It is important to watch the Claims and Eligibility/Electronic Commerce Alerts section of our Provider website at bcbstx.com/provider for news and updates related to electronic data interchange (EDI) transactions. See below for a quick summary of recently posted Electronic Commerce Alerts. If you utilize a billing service or clearinghouse to conduct electronic transactions on your behalf, please ensure they are aware of this information as well.

Billing Provider Address, Loop 2010AA

All HIPAA-standard electronic transactions submitted by covered entities must now be exchanged using the ANSI Version 5010 standards. The ANSI v5010 Technical Reports Type 3 (TR3s) specify that the Billing Provider Address must be a physical street address. P.O. Box or Lock Box addresses may only be submitted as the Pay-to Address (Loop ID-2010AB). This applies to all claim formats, i.e., Dental, Institutional and Professional (ANSI 837D, 837I and 837P).

Valid 9-digit ZIP Code (ZIP+4) Required

A valid 9-digit ZIP code is required in the billing address and service facility location (if different from billing). A 9-digit ZIP code is not required in any other address field; however, if a 9-digit ZIP code is entered, it must be valid, otherwise the claim will reject.

NPI – Get it, share it, use it!

Your NPI and other provider information should be reported consistently across all payers. For example, when billing Blue Cross and Blue Shield of Texas (BCBSTX), it is important to use the same NPI and address that was used when billing Medicare. To help ensure that your BCBSTX claims are properly processed and payments are sent to the correct location, the correct NPI(s) and other information must be on our provider file. This includes the rendering NPI, when applicable.

Quick Tip: Claim payment is determined by the data in our provider file, so be sure to check your information on our online Provider Finder®. If you need to make changes to your information on Provider Finder, visit the Network Participation/Update Your Information section of our website at bcbstx.com/provider.