4010 to 5010 Migration FAQs

Can I use a Lockbox Address for 5010 Claims Transactions?

Lockbox address can still be used but information must be entered in the right place. Providers will be required to use a street address in the Billing Provider Address section of the 837 (Data Elements N3 and N4 - Loop 2010 AA). However, a bank lockbox or P.O. Box address can still be used (and should be used, for PNC Bank lockbox customers) in the Pay-To Provider Address section of the 837 (Data Elements N3 and N4 - Loop 2010 AB).

For 5010 implementation, PNC Healthcare recommends that providers:

  • Use the street address in the Billing Provider Address section of the 837 v. 5010
  • Use the lockbox address in the Pay-To Provider Address section of the 837 v. 5010
  • Confirm that the lockbox address is the address of record on major payers' A/P systems, and that this address will not change when the payer implements 5010
What transactions are defined as HIPAA transactions?
  • Eligibility Inquiry/Response (270/271)
  • Claim Status Inquiry Response (276/277)
  • Prior Authorization Request/Response (278)
  • Premium Payment (820)
  • Benefit Enrollment/Maintenance (834)
  • Electronic Remittance Advice (835)
  • Professional Claim (837 P)
  • Coordination of Benefits - Professional (837 P COB)
  • Institutional Claim (837 I)
  • Coordination of Benefits - Institutional (837 I COB)
  • Dental Claim (837 D)
  • Coordination of Benefits - Dental (837 D COB)
  • Pharmacy Claim (NCPDP D.0/NCPDP 5.1 Batch/NCPDP 3.0 Batch)
  • Interchange Acknowledgment (TA1)
Will PNC accept both 4010 and 5010 transactions?

PNC will accept and process both 4010 and 5010 transactions. We will supply the transaction information to our trading partners and clients to accommodate each client's requirements.

For the first half of 2011, PNC will process in and process out the version that it receives.

Will PNC accept 999 and 277CA acknowledgements?

PNC will accept both the 999 and 277CA acknowledgements. At this point, we can send only the 999 acknowledgement.

Will 835 files be sent in both 4010 and 5010 formats to clients?

Until the 5010 835 goes into production, clients will receive the 835 in the version that was submitted. If the client cannot accept 5010, it can elect to not receive data. The 835 will be viewable within PNC Healthcare Advantage. Clients can contact their account manager if they have any concerns.

When will testing begin for the 5010 format?

PNC was ready to test in January 2011. PNC is currently testing strictly 5010A1 format.

How do I schedule 5010 testing with PNC?

PNC has scheduled testing throughout the remainder of 2011 with most clients. If you would like to test with PNC and have not been contacted, please send us an email at pncha@pnc.com and a PNC Healthcare representative will contact you.

In addition, PNC has created a 835 Remittance test file that providers can use to process through their billing system to determine 5010 version and production readiness. Click here for more information.

Is testing required?

PNC recommends that our trading partners and clients test with PNC to ensure that data and transmission requirements are met.

Will the same delivery method be used for both 4010 and 5010 files?

PNC will use the same delivery methods but will work with our clients and trading partners to accommodate any specific requirements when possible.

On what date will PNC begin to accept 5010?

Testing Date - January 17th, 2011

Production Date - February 5th, 2011

Will 4010A and 5010 be accepted in the same file?
PNC will accept content in multiple versions within the same file if the EDI and HIPAA standards are met for the versions submitted.
Can both version 4010A and 5010 be sent in separate files using the same Trading Partner Number?
PNC will assume that you will use the same Trading Partner Number for both versions. However our solution allows us the flexibility to accommodate many individual trading partner and client needs. We can work with our clients and trading partners on special accommodation requests for all transaction types exchanged.
Where can I see PNC Healthcare's testing schedule with payers and providers?
A PNC Healthcare will contact you to discuss projected testing dates.
One of our offices will not be compliant, because it only processes paper bills still. Does version 5010 affect this paper office?
No, HIPAA version 5010 only affects electronic billing.
After successfully transmitting or receiving 5010 files, when do I start sending 5010 files?
Once you have been notified by your Onboarding Project Manager at PNC Healthcare that you have completed testing, we will work with payers and providers on a mutually agreed production date. All payers and providers must be in 5010 compliance entirely by the HHS deadline of January 1, 2012.
What will happen with the Errata version?
The Errata version of 5010 will be supported.
Who do I contact at PNC Healthcare with questions regarding the 5010 upgrade?
During testing and migration, an Onboarding project manager will be the single point of contact to coordinate requirements gathering, testing, and production migration. If you are unsure who your Onboarding project manager is, please email pncha@pnc.com.

If you have any questions regarding PNC's 4010 to 5010 migration or other regulatory issues please email pncha@pnc.com.

PNC is a registered service mark of The PNC Financial Services Group, Inc. ("PNC"). Bank deposit products and services and Treasury Management services for healthcare providers and payers are provided by PNC Bank, National Association, Member FDIC, a wholly owned subsidiary of The PNC Financial Services Group, Inc.

2010 The PNC Financial Services Group, Inc. All rights reserved.

PNC is a registered service mark of The PNC Financial Services Group, Inc. ("PNC"). Bank deposit products and services and Treasury Management services for healthcare providers and payers are provided by PNC Bank, National Association, Member FDIC, a wholly owned subsidiary of The PNC Financial Services Group, Inc.

©2010 The PNC Financial Services Group, Inc. All rights reserved.