02/12 CMS 1500 Claim Form and Lytec 2014

 Lytec 2014 is the only version that includes fields, programming, and report forms necessary to produce the new 02/12 CMS 1500 Claim form. 

Timeline

The NUCC (National Uniform Claim Committee) has approved a transition timeline for the version 02/12 CMS-1500 Claim Form. In June, the NUCC announced the approval of the updated 1500 Claim Form that accommodates reporting needs for ICD-10 and aligns with requirements in the Accredited Standards Committee X12 (ASC X12) Health Care Claim: Professional (837P) Version 5010 Technical Report Type 3.

The NUCC approved the following transition timeline at its in-person meeting in Chicago on August 1, 2013.

  • January 6, 2014: Payers begin receiving and processing paper claims submitted on the revised 02/12 CMS-1500 Claim Form.
  • January 6 through March 31, 2014: Dual use period during which payers continue to receive and process paper claims submitted on the old 1500 Claim Form (version 08/05).
  • April 1, 2014: Payers receive and process paper claims submitted only on the revised 02/12 CMS-1500 Claim Form.

Changes to the 02/12 1500 form and where the data will pull from in Lytec 2014:

To accommodate the changes to the 02/12 CMS-1500 claim form, new fields have been added to the Billing Options – Billing Information tab. Use these fields for entering specific detail in boxes 8 and 9. These fields apply only to the 02/12 CMS-1500 Claim form.

Lytec Billing Info

Please note that only Lytec 2014 SP1 contains the 02/12 forms programmed with new requirements released by Medicare. Since these requirements did not come out until after Lytec 2014 had already been released any users that bill Medicare on paper will need to ensure that they are on Lytec 2014 SP1. Any notes in this article that mention how the box will be filled out for Medicare claims are only effective if the user is on Lytec 2014 SP1.

Form Changes:

This article only includes instructions for boxes on the 02/12 form that have changed from the 08/05 version. In the images below the 08/05 form is depicted in black and the new 02/12 form is in red. Where there was no visual change to the box only the description of the change is included.

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Box 1

Box 1 Insurance Type: Champus has been removed and changed to Tricare.

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Box 2 Patient’s Name: The NUCC suggests not printing the patient’s name when the patient is the subscriber. However, the patient’s name will continue to print on the form.

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Box 4 Insured Name: If the Insurance Type of the destination payer is worker’s compensation, the patient employer name will print. Lytec will print the value in the Specify Other Employer screen first. If that is blank, it will print the value in the Employer field.

When Medicare is the secondary insurance: If the primary insurance subscriber name is different than the patient’s name, Lytec will print the primary subscriber’s name. If the primary and secondary subscriber name is the same, Lytec will print SAME.

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Box 5 Patient’s Address: The phone number no longer prints based on the NUCC’s suggestion.

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Box 7 Insured Address: If the Insurance Type of the destination payer is worker’s compensation, the patient employer address will print. Lytec will print the value in the Specify Other Employer screen first. If that is blank, it will print the value in the Employer field.

When Medicare is the secondary insurance: If the primary insurance subscriber address is different than the patient’s address, Lytec will print the primary subscriber’s address. If the primary and secondary subscriber address is the same, Lytec will print SAME.

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Box 8

Box 8 Reserved for NUCC use: (Was Patient Status) This box displays the value entered for this box on the Billing Options – Billing Information tab. (New field in Lytec 2014 only)

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Box 9 Other Insured’s Name: When the primary insurance type is Medicare and secondary insurance is Medicaid, Lytec will leave this box blank. Otherwise, the current rules apply.

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Box 9a Other Insured’s Policy: When the primary insurance type is Medicare and the secondary insurance is Medicaid, Lytec will leave this box blank. Otherwise, the current rules apply.

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Box 9b

Box 9b Reserved for NUCC use: (Was Date of Birth and Sex) This box shows the value entered for this box on the Billing Options – Billing Information tab. (New field in Lytec 2014 only)

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10c

Box 9c Reserved for NUCC use: (Was Employer or School Name) When the primary insurance type is Medicare and the secondary insurance is Medicaid, Lytec will leave this box blank. Otherwise, this box shows the value entered for this box on the Billing Options – Billing Information tab. (New field in Lytec 2014 only)

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Box 9d Insurance Name: When the primary insurance type is Medicare and the secondary insurance is Medicaid, Lytec will leave the box blank. Otherwise, the current rules apply.

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10d

Box 10d Claim Codes (Designated by NUCC): (Was reserved for local use)  If the primary insurance type is Medicare and the secondary insurance type is Medicaid, Lytec will print MCD preceded by the Medicaid policy number. Otherwise, this box will print multiple condition codes separated by a space. This information reflects information from the More Billing Information -More Information 1 Tab.

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Box 11 Insured’s Policy Group or FECA number: If the primary insurance type is Medicare, Lytec will print NONE.

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11b

Box 11b Other Claim ID (designated by NUCC): (Was Employer Name) This box will print the value in the claim number field, preceded by a Y4 qualifier. The Claim Number field is found on the Billing Options -insurance tab.

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14

Box 14 Date Current Illness Injury or LMP: In addition to the date, there is a new Qualifier Code:

14 Qualifier

If the insurance is Medicare (primary, secondary, and so on), Lytec will not print a qualifier in the qualifier part in box 14.

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15

Box 15 Other Date: In addition to the date (selected based on which date field is completed in the order below), there is a new Qualifier Code:

15 Qual

If more than one of these is selected, Lytec will print the first one in the order listed above.

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17

Box 17 Referring Provider: This box can be used for various physician types. There are new qualifiers indicating the physician’s type:

17 Qualifiers

  • Only one can be used. If more than one exists on the billing, the system will use the following order: 1. referring, 2. ordering, 3. supervising.
  • If both supervising and referring exist on the claim, Lytec will print the referring provider.
  • If the Send Ordering Provider in Loop 2420E check box on the destination payer’s Insurance record is selected and there is a referring physician, Lytec will print DK (Ordering Provider) instead of DN.

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Box 17a Other ID: This box shows the ID of the provider from Box 17.

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Box 17B NPI Number: This box shows the NPI number of the provider from Box 17.

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19

Box 19 Additional Claim Information (designated by NUCC): (Was reserved for local use) Additional Claim Information (designated by NUCC)

19 info

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21

Box 21 Diagnosis Codes: Diagnosis codes 5-12 (indicated as E-L) have been added. Diagnosis codes are listed in order from left to right on three lines with four codes per line. In addition, there is an ICD Code Set Indicator:

21 Ind

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Box 24e Diagnosis Codes: This value now accepts alpha characters. Previously, only numeric values were reflected.

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Box 24h EPSDT:
Unshaded area:

  • If the EPSDT box in Patients – More Information 1 tab is selected and there is NO value in the EPSDT Conditional Code 1 field in the EPSDT/CRC section of the Bill Options – Billing More Information 2 tab, Lytec will print a Y.
  • If the EPSDT box is selected and there IS a value in the Conditional Code 1 field, Lytec will print the Code in Conditional Code 1. Y or the code will print on all lines that have a CPT code.
  • Print N if the EPSDT box in Patients – More Information 1 is selected and 1) there is no value in the EPSDT Conditional Code 1 field in the EPSDT/CRC section of the Bill Options – Billing More Information 2 tab, and 2) there is an N in the first character of the Referral items field on the Bill Options – More Billing Information 2 tab.

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Box 24 Transaction Description: Shaded area: If an NDC code is used, N4 will be printed and then the transaction NDC Code, a single space, followed by the NDC Unit of Measurement and NDC Unit Count. If you have entered text in the description field for a transaction, Lytec will print ZZ followed by the transaction description. If both are used, Lytec will print the NDC information first.

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30

Box 30 Balance Due: No longer used.

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Lytec Note

We highly recommend studying both the 02/12 1500 Instruction Manual found at Nucc.org and the Lytec Release Notes found here: Lytec 2014 Release Notes

Note: Medicare did not release the instruction manual for the new CMS-1500 02/12 Form until after Lytec 2014 was released. Therefore, users will need to install Lytec 2014 SP1 in order to print a paper claim formatted to Medicare’s specifications. Links to download SP1 can be found here. The Lytec 2014 SP1 Release Notes contain instructions on how Lytec populates the claim form for Medicare.

DISCLAIMER: Although AZCOMP Technologies, Inc. makes every effort to ensure that information regarding billing guidelines are checked and accurate in both our documentation and training, it should be understood that our expertise is in the software itself and not in billing practices. Therefore, it is the sole responsibility of the user to study, interpret and remain abreast of billing requirements and deadlines, contacting authoritative sources directly as needed. Any claims documentation and training provided by AZCOMP Technologies, Inc. is based on our interpretation of the rules published by nucc.org and cms.gov and  are subject to change. Information and training provided is “as is” and without any express or implied warranties. AZCOMP Technologies, Inc. assumes no responsibility for any inaccuracies, errors, or omissions, expressly disclaiming liability for damages of any kind arising out of the use of, reference to or reliance on any content provided.