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A large number of 5010 claims are being rejected by payers when providers include:

- Incorrect Provider NPIs in the billing and rendering physician fields
- A Tax Identification Number that is not linked to their Provider NPI

As a reminder, per 5010 claim requirements, the Provider NPI for the rendering physician may not be the same as for billing physician. If incorrect information is entered for this field, the Tax ID is used for alternate identification. Thus, correct information is required in both fields.

While these types of rejections could happen with any payer, the clearinghouse identified this problem with Health Care Services Corporation (HCSC) and let them know we have been seeing a spike in these rejections since February 7, 2012.

If you receive a payer claim rejection of this type, HCSC recommends you contact them directly at 800-746-4614 to verify the correct provider information to be included on these claims.

CPIDs impacted:
CPID 1405 Illinois Blue Shield
CPID 5508 Illinois Blue Cross
CPID 7403 Oklahoma Blue Shield
CPID 1514 Oklahoma Blue Cross
CPID 1403 New Mexico Blue Shield
CPID 5565 New Mexico Blue Cross
CPID 1406 Texas Blue Shield
CPID 5501 Texas Blue Cross

Ensure that the correct provider NPI and Tax ID are being input for 5010 claims. For payer claim rejections due to this issue, contact HCSC to determine the correct NPI to be reported so that the claims will get processed.

If you have any questions, please contact Client Services at 1-888-348-8457, option 2.


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