The April 1st Deadline to start using the new CMS 1500 02/12 form is quickly approaching.
All paper claims including Rebills must be on the new CMS form starting April 1, 2014. The majority of practices still drop a portion of their claims to paper. All those practices are required to start using the new form on 4/1/14. Any paper claims sent on the old form past 4/1/14 will be rejected.
There are a lot of questions out there about this new form. We have written a few posts about this subject previously, but we wanted to post a list of Frequently Asked Questions, with answers for your reference. Also in this post you will find an “At A Glance” view of the changes to the form.
First, here are the links to a few previous posts that users have found very helpful.
02/12 CMS 1500 Form at a Glance
Download a 1 page guide of the changes to the claims form here: Revised CMS Claim Form at a glance. For the all the details you can view a previous blog post here: Revised CMS 1500 Form Changes At A Glance
FAQ For 02/12 CMS 1500 Claim Form
Q: When do I HAVE to use the new form?
A: April 1, 2014 all paper claims must be on the new form (including Rebills).
Q: When can I start using the new form?
A: January 6 to March 31: you can bill on the new or the old form.
Q: Do I have to upgrade?
A: Yes. Only Medisoft v19 and Lytec 2014 have the fields, programming and features necessary for the 02/12 form.
Q: What has changed on the new form?
A: Two goals for the 02/12 Form.
1. Align the form with what is sent electronically.
– OMITTED INFORMATION from the form because that information is not sent on an electronic claim.
– RESERVED FOR NUCC USE boxes have replaced several of the existing boxes on the new form (insurance companies can opt to use these fields to collect specific information, NEW FIELDS ADDED TO MEDISOFT V19 & LYTEC 2014 to accommodate for this change.)
– NEW INFORMATION included on the form such as Condition Codes.
– QUALIFIERS ADDED to many existing boxes to specify type of infomrmation being sent (Example: A qualifier has been added to box 17 to indicate whether the provider noted in the box was the referring, ordering, or supervising provider.)
2. Accomodate ICD-10
– REPORT UP TO 12 DX CODES (old form had space for 4)
– ICD INDICATOR tells insurance if codes are ICD-9 or ICD-10
– ALPHA DX POINTERS instead of numeric
Q: Can’t I just modify my existing form?
A: No. In addition to having new fields to pull data from, there is conditional logic built into the 02/12 form in the program that fill out the fields and populate the new qualifiers according to NUCC and Medicare specific guidelines.
Q: Do I have to update to Service Pack 1 (SP1)?
A: If you bill to Medicare, then YES, you do need to update to SP1.
Q: Where can I learn more about the changes and how they affect my program?
A: Right here on this blog! We have a few links above that are helpful with additional information. Also, AZCOMP currently has 2 webinars scheduled on this specific subject. If you have more questions, please attend! The webinars are scheduled for March 25th and 26th. You can register by going to www.azcomp.com/register.
Q: My clearinghouse prints paper claims for me, do I have to do anything?
A: Yes. RelayHealth has new CPID’s that must be added to the insurance to indicate that claims for that carrier will be dropped to the new form. Check with your clearing house to verify how they are handling the transition.
Those are the most frequent questions we have been hearing about. If you have additional questions, please attend our webinar!
Form CMS 1500 Training Videos
In a recent webinar, our amazing trainer provides great details about the changes to the claims form. The first training video is 17 minutes and reviews the background behind the new revisions, it also compares the old form and the new form side by side.
New CMS 1500 02/12 Form- History & Comparison
9 minute video comparison of the old form and the new form
Again if you have any questions, please leave a comment here in this post, or you can attend one of our upcoming webinars.