CMS Implementing Updated 1500 Claim Form

CMS has recently announced that they will be implementing an updated CMS 1500 form for all paper claims filed to Medicare.  The revised CMS 1500 form (version 02/12) will have the following additional functionalities:

• Indicators for differentiating between ICD-9-CM and ICD-10-CM diagnosis codes.

• Expansion of the number of possible diagnosis codes to 12.

• Qualifiers to identify the following provider roles (on item 17)

  • Ordering
  • Referring
  • Supervising

Medicare has established the following tentative timeline to phase in the use of CMS 1500 form (version 02/12):

  •  January 6, 2014: Medicare begins receiving and processing paper claims submitted on  the revised CMS 1500 claim form (version 02/12).
  •  January 6 through March 31, 2014: Dual use period during which Medicare continues to receive and process paper claims submitted on the old CMS 1500 claim form (version 08/05).
  •  April 1, 2014: Medicare receives and processes paper claims submitted only on the revised CMS 1500 claim form (version 02/12).

In addition, CMS is currently updating the Medicare Claims Processing Manual with instructions about completing the revised forms.

Please see the full notice in the following MLN Connects Newsletter:

 http://www.cms.gov/Outreach-and-Education/Outreach/FFSProvPartProg/Downloads/2013-06-27Enews.pdf

In addition, the new version of the CMS 1500 form can be viewed at the following link:

  http://nucc.org/images/stories/PDF/1500_claim_form_2012_02.pdf

In preparation to begin using the revised forms, SHP encourages our clients to work with their EDI vendors/clearinghouses/billing software companies to ensure compliance with the new CMS 1500 forms.