Use New CMS-1500 Claim Form by April 1

Have you started using the latest version of the CMS-1500 claim form (PDF), either paper or its electronic equivalent? You can start using the new form now, but beginning April 1, payers no longer will accept the older version of the form for payment. You also must use the form for bills submitted for workers' compensation medical services beginning April 1.

The revised CMS-1500 claim form (PDF), version 02/12, accommodates reporting needs for the ICD-10 code set and aligns with current standards for electronic health care transaction. 

Notable changes include the ability to identify whether the claim is using ICD-9 or ICD-10 as the diagnosis code set, and a diagnosis field allowing up to 12 codes instead of the current limit of four. In addition, for Medicare claims, the new form accommodates qualifiers to identify certain health professionals as having performed an ordering, referring, or supervising role in the furnishing of the service. See the Centers for Medicare & Medicaid Services' MLN Matters No. MM8509 (PDF) for more information about using the revised form for Medicare claims. 

The American Medical Association offers five steps your practice should take now to prepare for the switch: 

1.  If you use a paper form, obtain the revised form from your supplier.

2.  If you use a digital version, contact your practice management system vendor to coordinate your software upgrade.

3.  Determine when the payers and other trading partners, such as clearinghouses, will begin accepting the revised form.

4.  Conduct testing with your trading partners.

5.  Monitor how your claims are being processed using the new form so you can identify any possible issues.

The National Uniform Claim Committee, which maintains the CMS-1500 claim form, provides online instructions and other help.

Published Feb. 25, 2014

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