All Professional Providers Billing Medicare and Other Payers
Beginning April 1, 2014, all providers processing claims to Medicare must begin using the new 1500 Claims Form, Version 02/12.
Form Version 02/12 will replace the current CMS 1500 claim form, 08/05, effective with claims received on and after April 1, 2014:
- Medicare began accepting claims on the revised form, 02/12, on January 6, 2014;
- Medicare is continuing to accept claims on the old form, 08/05, through March 31, 2014;
- On April 1, 2014, Medicare will accept paper claims on only the revised CMS 1500 claim form, 02/12; and
- On and after April 1, 2014, Medicare will no longer accept claims on the old CMS 1500 claim form 08/05.
What is Different on the 1500 Claims Form, Revised Version 02/12?
The National Uniform Claim Committee (NUCC) recently revised the CMS 1500 claim form revised form, 02/12.
The revised form has a number of changes. Those most notable for Medicare are:
- new indicators to differentiate between ICD-9 and ICD-10 codes on a claim,
- the form uses letters, instead of numbers, as diagnosis code pointers,
- it expands the number of possible diagnosis codes on a claim to 12,
- added qualifiers to identify whether certain providers are being identified as having performed an ordering, referring, or supervising rolein the furnishing of the service.
- DN – Referring Provider
- DK – Ordering Provider
- DQ – Supervising Provider
* Providers should enter the qualifier to the left of the dotted vertical line on item 17.
The Administrative Simplification Compliance Act (ASCA) requires Medicare claims to be sent electronically unless certain exceptions are met.
Those providers meeting these exceptions are permitted to submit their claims to Medicare on paper. Medicare requires that the paper format for professional and supplier paper claims be the CMS 1500 claim form and its revisions for use by its professional providers and suppliers meeting an ASCA exception. More information about ASCA exceptions can be found in Chapter 24 of the “Medicare Claims Processing Manual” which is available at:
http://www.cms.gov/Regulations-and-Guidance/Guidance/Manuals/Downloads/clm104c24.pdf on the Centers for Medicare & Medicaid Services (CMS) website.