The White House Office of Management and Budget (OMB) recently approved the revised CMS 1500 claim form, version 02/12. A tentative implementation plan expects the new form to be in use in January 2014.
The National Uniform Claim Committee (NUCC), an industry organization comprising the Centers for Medicare and Medicaid Services (CMS) and others, revised the form and submitted the changes for review in 2012. Among other changes, the new form will accommodate ICD-10-CM diagnosis codes, allowing for indicators between ICD-9 and ICD-10 and increasing the possible number of diagnosis codes to 12.
Instructions for completing the revised form are being added to the Medicare Claims Processing Internet Only Manual (IOM, Pu. 100-04) Chapter 26, and the updated version of that document will be announced by CMS when complete.
According to the CMS MLN Connects Provider eNews from Thursday, June 27, 2013, Medicare anticipates accepting the new form beginning January 6, 2014, with a dual use period of the old (version 08/05) and new (version 02/12) forms through March 31, 2014. Tentatively, Medicare will process only the version 02/12 form beginning April 1, 2014. The official dates will be announced by CMS when they are determined.
To receive copies of the 02/12 1500 Claim Form, contact:
- Your current forms supplier;
- TFP Data Systems: 1500form@tfpdata.com or 800-482-9367 ext. 58029; or
- The Government Printing Office: http://bookstore.gpo.gov/catalog/government-forms-phone-directories or 866-512-1800.
TFP has the print files and specifications available since of June 20, 2013.
For more information about the revisions to the claim form or the timeline for implementation, visit the NUCC website.
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