NEW CMS 1500 CLAIM FORM

CMS previously published Change Request 4293 outlining instructions for use of the new CMS 1500 claim form. Click for the Change Request 5060 which makes some minor changes to the print file and text, but more importantly changes the effective date for use of the new form. Providers may begin using the form on January 2, 2007 instead of October 1, 2006 as previously announced.

As of April 2, 2007 the old version of the form (12/90) will be discontinued, and only the CMS 1500 (08/05) version form will be accepted for new or revised billings.

We would appreciate your assistance in disseminating these important dates to your associates and members:

January 2, 2007: Health plans, clearinghouses, and other information support vendors shall be ready to handle and accept the revised Form CMS-1500 (08/05).

January 2, 2007 – March 30, 2007: Providers can use either the current Form CMS-1500 (12/90) version or the revised Form CMS-1500 (08/05) version.

April 2, 2007: The current Form CMS-1500 (12/90) version of the claim form is discontinued; only the revised Form CMS-1500 (08/05) is to be used. All rebilling of claims should use the revised Form CMS-1500 (08/05) from this date forward, even though earlier submissions may have been on the current Form CMS-1500 (12/90).

Medicare Provider Outreach and Education

Customer Service 877-527-6613