Q: What is going on with the updated version of the CMS1500 (formerly HCFA1500)? I thought I had an option to use it beginning on Jan. 1, 2007, with mandatory use as of April 1, 2007. Now I hear that the mandatory date for use has been extended. Could you please help? I am confused and want to make sure I file my insurance claims correctly. I cannot afford any delays in payment.
A: As you are aware, there is an updated version of the CMS1500 (8/05). This change was promulgated by the use of the National Provider Identifier number (NPI#), under the simplification protocol of HIPAA. Beyond the NPI#, there were also some changes to make the form more specific. The revision was finalized in July 2006 and was scheduled for initial use in October 2006. However, as you have become aware and noted in your question, that date was extended to Jan. 1, 2007 and then later to April 1, 2007. And yes, surprise, surprise, it has been extended again. As of this writing, CMS is giving a target day of June 1, 2007. This means you can continue to use the old version of the CMS1500 (12/90) until that time.
But stay tuned, as this date may be extended yet again. CMS is noting June 1, 2007 as a "target" date.
This latest postponement is related to a printing error from a government printing office, which means there are possibly some incorrect versions of the form in circulation. If you happen to be using the new form - you can use either version - and it is incorrect, CMS has directed intermediaries to send incorrectly formatted forms back to you. Therefore, if you are using the wrong form, you will get notification from the carrier directly.
To quickly identify if the form you have is the correct version, consider that the revised version states, "Approved OMB-0938-0999 FORM CMS-1500 (08-05)" on the bottom of the form, signifying August 2005 version. The best way to identify if your CMS1500 (08-05) forms are correct is by looking at the upper-right-hand corner of the form. On properly formatted claim forms, there will be approximately a quarter-inch gap between the tip of the red arrow, above the vertically stacked word CARRIER, and the top edge of the paper. If the tip of the red arrow is touching, or close to touching, the top edge of the paper, then the form is not printed to specifications.
Please be aware that this issue involves the use of the form only and does not change the need for having your NPI# by the May 23, 2007 deadline. If you have not received your NPI#, go to https://nppes.cms.hhs.gov/NPPES or call (800) 465-3203 for a paper application form.
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