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.
Important Dates to Note:
- January 6, 2014 – Medicare will begin accepting claims on the new version 02/12.
- March 31, 2014 – Medicare will no longer accept claims on the old version 08/05 after this date.
- April 1, 2014 -- Medicare will only accept claims on the new version 02/12.
- October 1, 2015 – ICD-10 Implementation
Why is there a new claim form?
The new form is designed to accommodate the change to ICD-10. It provides fields that allow you to use the longer codes and enter more codes. Updates were also devised to create consistency with the data submitted on electronic claims (837P) as well as overall improvements to the usability of the form.
What changes impact the transition from ICD-9-CM to ICD-10-CM?
Diagnosis Codes – Allows up to 12
The new form allows support of up to 12 Diagnosis Codes, however, what has not changed is that each procedure will still only allow up to 4 diagnosis pointers. This means that this new form can still only support 4 diagnosis codes per procedure.
Diagnosis Pointers (Numeric to Alphanumeric)
The diagnosis pointers (Box 24E) will be moved over from numbers to letters for ICD-10.
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 2015.
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.
- Best to work closely with staff and ensure updates to system and claims are made
- Monitor payer websites to ensure no delay in reimbursement
- If you have provider representatives, reach out to them and see if they finalized the transition to the new payer.
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 written support documentation from the payer for Kareo to implement such customizations. 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?
Guide to CMS-1500 Claim Form Version 02/12
Print Paper Claims
Configure Paper Claim Settings
I selected the new version in the batch feature for paper claims printing, why aren’t any claims printing?
If the claims have a ready to send claim status and they are queued for printing, your insurance company paper claim settings may not be set up properly. You want to check your paper claims setting and ensure the new version is selected.
- Go to Settings > Insurance > Find Insurance Company.
- Search for and open the Insurance Company.
- Click the Paper Claims Tab.
- Confirm that CMS 1500 Form - Version 02/12 is selected for primary and/or secondary billing form.
- Click Save.
- Reprint your 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.