Major Updates to the Current Medical Claim Form Are Upon Us

The Centers for Medicare and Medicaid Services (CMS) along with the Office of Management and Budget (OMB) have given final approval for the Version 02/12 1500 Health Insurance Claim Form and the implementation date of April 1, 2014 is fast approaching. Failure to use these new forms can result in significant delays in processing medical payments as well as a possible rejection of certain claims.

The new form has been revised to accommodate reporting needs for ICD-10. New ICD-10 codes will be required for all claims on services performed on October 1, 2014 or later.

The revised 02/12 1500 Health Insurance Claim Form also aligns with requirements in the Accredited Standards Committee X12 (ASC X12) Health Care Claim: Professional (837P) Version 5010 Technical Report Type 3.

Time is running out so now is the time to order a new inventory of Health Insurance Claim Forms. The Dual Use Period will officially end on March 31, 2014. According to the National Uniform Claim Committee timeline and the Medicare and Medicaid services timeline, beginning April 1, 2014, all claims for private insurers and Medicare must be submitted solely on the revised 1500 Claim Form (version 02/12).

To obtain copies of the 02/12 1500 Insurance Claim Form, you can contact:

  • Your current forms supplier who should have updated copies of the forms available
  • TFP Data Systems: 1500form@tfpdata.com
  • Call TFP Data at 800-482-9367 ext. 58029
  • Government Printing Office http://bookstore.gpo.gov/catalog/government-forms-phone-directories or 866-512-1800

Effective April 1, 2014, all providers must have updated software in order to properly submit CMS 1500 (02/12) claims. If your software provider has not already contacted you concerning this update, contact them to avoid having any claims rejected. This software update can normally be done quickly but older computer systems may require upgrades to accommodate the changes.

It is also important to note that a change has been made to the new form since the dual-use period. It is now necessary to specify whether you are using ICD-9 or ICD-10 diagnostic codes. There are also eight additional diagnosis codes on the revised form. Each of these codes relates to specific data associated with the patient’s condition and treatment regiment and need to be accounted for on the forms. Make sure to check with your vendor to see that they are aware of the changes and have made accommodations. Finally, once you have your new CMS 1500 02/12 forms, make sure to recycle or dispose of any old forms to avoid using them in error.

There is a rough timeline that has been established for implementing these new forms and some key dates include:

January 6, 2014 – Medicare begins accepting and processing medical claims submitted on the new CMS 1500 form (version 2/12).

January 6, 2014 – March 31, 2014 – Grace period where Medicare will process both the older CMS 1500 and the newer revised form to give medical providers time to transition.

April 1, 2014 – Medicare will only accept claims submitted on the newer CMS 155 (version 2/12) form for treatment.

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