ANSI 5010 and ZIP Codes

Once again, it seems I’m writing to correct misinformation doctors are getting en masse at seminars. And once again, keep in mind where my information is coming from. I certified ECLIPSE as ANSI 5010 compliant for electronic claims months ago and have all the official documentation in hand.

Several times in the past week, panic has set in when doctors have been told that all the ZIP codes they submit will have to be converted  to full 9 digit codes. Not true.

Of course, it’s easy to see how such misinformation came to be. So, what’s the story? And what do you need to do? Your address (i.e. billing provider and service facility) must contain a 9 digit ZIP code. This is stated clearly on page 93 of the most recent (February 2011) Consolidated Guide for 837 Professional claims.

So, update the addresses for every provider in your practice that may appear on claims. If you have multiple facilities and treat patients at multiple locations, update those as well. That’s it. It’s not required that you update each patient, guarantor, payer, etc. in ECLIPSE.

If you don’t know your 9 digit ZIP code, you can look it up here.

By the way, ANSI isn’t just about 837. ECLIPSE directly imports 835 electronic remittance, as well as 277 & 999 type acknowledgments. And if the software you use doesn’t create detailed 277 & 999 reports, you have no way of knowing the status of your claims!

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