CMS-1500 Claim Form Version 02/12
On June 10, 2013 the White House Office of Management and Budget (OMB) approved a revised CMS-1500 form updated by the National Uniform Claim Committee (NUCC). Beginning April 1, 2014, the new form, version 02/12, will replace the current version 08/05. Dates to note:
- January 6, 2014: Medicare will begin accepting claims on the new version 02/12
- Medicare will continue to accept claims on the old version 08/05 through March 31, 2014
- April 1, 2014: Medicare will only accept claims on the new version 02/12
What changes impact the transition from ICD-9-CM to ICD-10-CM?
- The new form allows a practice to designate which version of the ICD code is included in the form: “9” for ICD-9 and “0” for ICD-10. However, until ICD-10 goes into effect, the ICD Indicator field will only submit the indicator for ICD-9; note that some payers may opt to not include the indicator until ICD-10 is in effect.
- The form now supports submission of up to 12 Diagnosis Codes (Item/Box 21) per form to align with the electronic claim version (837P).
- The diagnosis pointer (Item/Box 24E) now utilizes alpha characters instead of numbers.
The new form now allows submission of up to 12 Diagnosis Codes – does this mean I can now submit 12 diagnosis codes on my claim?
Even though the new claim form allows submission of up to 12 diagnosis codes, it still only allows four diagnosis codes per line item or procedure. The diagnosis pointer field only allows 4 pointers per line item. In order to submit 12 diagnosis codes, the claim will need at least a minimum of 3 line items, each pointing at 4 unique diagnosis codes.
With the CMS deadline of April 1, 2014, does this mean that all paper claims will need to be submitted on the new form regardless of the date of service? What about claim resubmissions that I previously submitted on the old form?
The requirement applies to all paper claims received by CMS on or after April 1, 2014, regardless of the date of service or previous claim submission. Kareo recommends transitioning to the new form by the middle of March to ensure that all claims received by Medicare and Medicaid are already on the correct form by the deadline.
Are all payers required to transition to this new form on the same dates as noted by Medicare?
At this point, only Medicare, Medicaid and Medicare/Medicaid Replacement plans are mandated to adhere to the CMS schedule. Commercial payers will likely transition in the coming months leading to the implementation of ICD-10 in October 2014.
How do I know if my non-Medicare/Medicaid payer has transitioned to the new form?
Though most payers are proactive in notifying their providers of these types of changes, their method of notification is not always effective. It is best to work closely with your staff to ensure that updates to your system and claims printing are made. You can also monitor the payer sites for your major payers to ensure that there is no delay in reimbursement. If you have provider representatives for your major payers, reach out to them to see if they have finalized their transition to the new form.
Will this new form require me to change my current process or method for posting charges?
Prior to the implementation of ICD-10, the form itself will not require you to change your current method for posting your charges, however, payers may choose to utilize the new fields in the form and may require you to submit additional data with your claim.
My current CMS-1500 (08/05) paper claim form is customized for some of my payers; will that customization be the same in this new form?
The new CMS-1500 paper claim form has some significant field and field requirement changes, and not all customizations will translate from the old form. In order for Kareo to apply these customizations to the new form, you will need to obtain the payer’s specifications. Kareo will gladly work with you and your staff to ensure that the proper requirements are applied.
Where can I find instructions for setting up this new form?
When I go to the (Batch) Print Paper Claims window and I pick the new form (Version 02/12) in the Claim Type drop box, the claim I was expecting is not printing even though it shows that there are claims ready for printing. What am I doing wrong?
If the claims queued for printing are for insurance companies that are currently not configured to utilize the same paper Claim Type you selected, then nothing will print. To check your settings:
- Go to Settings> Insurance > Find Insurance Company.
- Locate the insurance company and click on it to open.
- Click the Paper Claims tab at the top of the window.
- Confirm that both the Primary Billing Form and Secondary Billing Form are configured to the correct paper claim form.
- Click Save.
- Return to the (Batch) Print Paper Claims window, select the Claim Type and click Print Claims to generate the paper claims.
If a claim I submit on this new form is rejected for not submitting the correct data on one of the new or updated fields, is there a special number or contact I should reach out to for assistance?
Kareo understands that any delay in reimbursement impacts your practice. To ensure a consistent response, contact Kareo Support and any issues will be escalated internally to the proper team to ensure an expedited resolution.
Where can I get additional help if I cannot find the solution in your online documentation?
If you still need assistance after reviewing the online documentation, please contact Kareo Support.
Still need help? Contact support here.