TIPS, TRICKS AND TACTICS: YOUR GUIDE TO THE NEW CMS 1500-FORM

STEP-BY-STEP INSTRUCTIONS EASE THE TRANSITION

As you’ve no doubt heard, Medicare has revised its 1500-Form to accommodate the new National Provider Identifier (NPI) it is in the process of implementing. While the changes to the form are not extensive, they is designed to ensure you provide both your Legacy ID and the new NPI whenever possible before May 23, 2007. After that date, Medicare will require you to submit all claims with your NPI only.

The Centers for Medicare and Medicaid Services (CMS) had originally planned to roll out the new 1500 in January, but has since postponed final implementation until April 2, 2007 – although local carriers were nonetheless required to be able to accept the new form as of Jan. 1.

Here’s an overview of important dates concerning the revised form:

Jan. 1, 2007: Providers could begin using the revised CMS-1500. Payers and clearinghouses were required to be ready to accept the new forms on this date.

April 2, 2007: Providers will be required to use the new CMS-1500 for claims filed on or after this date.

May 23, 2007: Providers are required to start reporting only NPIs in place of their PINs.

If you would like to take a look at the new form, copies are available from the Government Printing Office at (202) 512-1800 or from TFP Data Systems at (800) 482-9367, ext. 1770. In addition, a PDF-version of the 1500-Form can be obtained from the National Uniform Claim Committee website at www.nucc.org. Select the “1500 Claim Form” tab on the top menu bar.

CMS also offers technical instruction regarding the changes to the form at: www.cms.hhs.gov/MLNMattersArticles/downloads/MM5060.pdf.

In the meantime, we’d like to provide you with an overview of what you will need to consider when working with the Navicure view of the revised form. One special note: If you have already provided Navicure with NPI data, field 24J will be automatically populated and will therefore offer “read only” functionality at this time.

  • The Referring or Ordering Physician’s provider number or UPIN – will need to be located in Field 17a (ANSI: 2310A Loop).

  • The Referring or Ordering Physicians new NPI – should be located in Field 17b (ANSI: 2310A Loop).

  • The Rendering Physician’s Legacy PIN and new NPI claim level and/or service level are displayed in Field 24J (ANSI: 2310B/2420A Loop).

  • The Service Facility Legacy ID and the Service Facility NPI – will be reflected in Section 32 (ANSI: 2310D Loop).

  • The Rendering Provider’s Legacy PIN and the Billing Provider’s Legacy GRP number – both should be located in Section 33 (ANSI: 2010AA/2310B Loops).

  • Finally, the Rendering Provider’s NPI and the Billing Provider’s NPI will be found in the appropriate fields at the bottom of Section 33 (ANSI: 2010AA/2310B Loops).

To help ease your transition, Navicure has developed a Web-based flash demonstration to provide brief step-by-step instructions on how to complete Form 1500 correctly. To view the demo, follow this link: www.navicure.com/demos/New_1500_Form.swf.

Of course, if you have additional questions, feel free to contact the Navicure Client Service team at 770-342-0800 or clientservices@navicure.com.

 

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