CMS Extends April 1 Deadline for Using New Claim Forms
by Government Relations and Legal and Regulatory Affairs Staff
March 29, 2007 -- The Centers for Medicare and Medicaid Services (CMS) has delayed until at least June 1, 2007 the date by which providers who bill paper claims to Medicare must use the new CMS-1500 form. Initially, the new forms, which were redesigned to accommodate National Provider Identification numbers (NPIs), were to be used exclusively no later than April 1.
However, CMS learned that some of the forms issued by the Government Printing Office, and possibly other vendors, were formatted incorrectly and cannot be processed. As a result, the federal agency has extended the deadline for using the new paper forms to enable providers who have incorrect forms to replace them.
June 1 has been set as a “target date” for mandatory use of the new paper claim forms, pending a final decision by CMS. The old forms have “Approved OMB-0938-0008 FORM CMS-1500 (12/90)” printed at the bottom. The new version of the form indicates “Approved OMB-0938-0999 FORM CMS-1500 (08/05).”
If you submit a claim for Medicare services on an improperly formatted CMS-1500 (08/05) form, the Medicare carrier will reject that claim and you will be expected to resubmit it on either an old CMS 1500 (12/90) or a properly formatted new CMS 1500 (08/05) form.
If you have improperly formatted paper forms, you also will need to check with the non-Medicare payers with which you do business to confirm that they will accept the old CMS 1500 (12/90) forms and find out how long they will do so.
To determine whether your new paper forms can be used, the CMS Web site, www.cms.hhs.gov, advises that you look at the upper right hand corner of a form. If the tip of the red arrow above the vertically stacked word “CARRIER” is touching or close to touching the top edge of the form, then the form is not printed to specifications. There should be approximately one quarter of one inch between the tip of the arrow and the top edge of the paper on the properly formatted form. CMS further notes that they cannot be certain that the problems with the forms are limited to this error involving the margin.
Importantly, the delay in the deadline to use the new forms does not directly affect the May 23, 2007 deadline for providers to begin using their National Provider Identifier (NPI). Providers who submit Medicare claims electronically must use their NPI as of May 23. Health professionals who have the correctly formatted version of the new CMS-1500 (08/05) must include their NPI on the form as of May 23. However, providers who opt to continue billing using the old CMS-1500 (12/90) should not include their NPI on that form, even after the May 23, 2007 deadline, since the old CMS forms do not have space to report an NPI.
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