March 2007

CMS extends deadline for new 1500 form

The Centers for Medicare and Medicaid (CMS) Services has extended its deadline for using its revised 1500 form because of incorrect formatting of the new form. A June 1 deadline for implementation is being targeted.

In July 2006, the Form CMS-1500 (12-90) was revised by the National Uniform Claim Committee (NUCC) predominantly for the purpose of accommodating the National Provider Identifier.

Since that time, the industry has been preparing for the implementation of the revised Form CMS-1500 (08-05). In September 2006, Medicare announced it would implement the revised Form CMS-1500 (08-05) on Jan. 1, 2007, with dual acceptability of both versions until March 31, 2007. According to the plan, beginning April 1, 2007, the only acceptable version of the form would be the Form CMS-1500 (08-05) and the prior version, Form CMS-1500 (12-90), would be rejected.

CMS has discovered there are incorrectly formatted versions of the revised form being sold by print vendors, specifically the Government Printing Office (GPO). GPO has determined that the source files it received from the NUCC’s authorized forms designer were improperly formatted. This resulted in the sale of both printed forms and negatives which do not comply with the form specifications.

CMS has decided to extend the acceptance period of Form CMS-1500 (12-90) version beyond the original April 1 deadline while this situation is resolved. Contractors will be directed to continue to accept the Form CMS-1500 (12-90) until notified by CMS to cease.

The old version of the form contains “Approved OMB-0938-0008 FORM CMS-1500 (12-90)” on the bottom of the form (typically on the lower right corner) signifying the version is the December 1990 version.

The revised version contains “Approved OMB-0938-0999 FORM CMS-1500 (08-05)” on the bottom of the form signifying the version is the August 2005 version.

On properly formatted claim forms, there will be approximately a one-quarter inch gap between the tip of the red arrow above the vertically stacked word “CARRIER” and the top edge of the paper. If the tip of the red arrow is touching or close to touching the top edge of the paper, then the form is not printed to specifications.

It is important to note that this issue involves the implementation of the new Form CMS-1500 (08-05) only and does not impact the May 23, 2007, implementation date of the NPI.

Questions may be directed to Brian Reitz at Brian.Reitz@cms.hhs.gov.

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