Payers will begin accepting the revised CMS 1500 claim form, version 02/12 on January 6, 2014. The revised claim form was approved by The White House Office of Management and Budget (OMB) in the summer of 2013.
The National Uniform Claim Committee (NUCC), an industry organization comprising the Centers for Medicare and Medicaid Services (CMS) and other health care industry stakeholders representing providers, payers, designated standards maintenance organizations, public health organizations, and vendors, revised the form and submitted the changes for review in 2012. Among other changes, the new form accommodates ICD-10-CM diagnosis codes, allowing for indicators between ICD-9 and ICD-10 and increasing the possible number of diagnosis codes to 12.
According to the NUCC implementation timeline, payers will begin 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. Payers will receive and process only the version 02/12 form beginning April 1, 2014.
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.
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.
For more information about the revisions to the claim form or the timeline for implementation, visit the NUCC website. Also, to review more specifically the changes to the revised CMS-1500 form, review the NUCC slideshow, “The 02/12 1500 Claim Form: Understanding the Changes to the Form.”
Under the Administrative Simplification Compliance Act (ASCA), providers are required to submit Medicare claims electronically unless certain exceptions are met. Some Medicare providers qualify for these exceptions and send their claims to Medicare on paper. Claims sent electronically must abide by the standards adopted under the Health Insurance Portability and Accountability Act of 1996 (HIPAA), which currently is the 5010 version of the ASC X12 837 Professional Health Care Claim standard and its implementation specification, Technical Report 3 (TR3).
More information about the ASC X12 and TR3 is available on the ASC X12 website.
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