Here are some commonly asked questions about the new 1500 Health Insurance Claim form.
Is this the same form as the CMS-1500?
YES and NO. Officially, the proper name is now the 1500 Health Insurance Claim Form. It is approved by government agencies, such the Centers for Medicare and Medicare Services (CMS), but it is not their form. Hence, the former titles of "HCFA-1500" or "CMS-1500" are now obsolete. As with any change, it takes awhile for common expressions to be incorporated into daily usage. With this opening paragraph, perhaps we can adjust sooner, rather than latter. It will probably be just the "1500 Claim Form", "1500 HIC", or the "1500"?
How can we tell them apart?
It is easy, and at first glance. The old CMS-1500 had big black bar codes on the top left. They are gone. Now there is just a simple clean rectangular box with "1500" inside the box.
Why do we need a new 1500 form?
Because you want your claim to get paid and not rejected. The implementation of the new National Provider Identifier (NPI) makes it crucial to have better reporting capabilities. The old CMS 1500 claim form hasn't been updated in 17 years. It simply became inadequate for today’s needs.
What was changed?
For a summary report of all that was changed on the 1500 form, click here.
Who needs to be using the new 1500 form?
Anyone who does billing either by paper or electronically. Those who send their data to an Electronic clearing house need to send the claim data in the new 1500 format.
When can I start using the new 1500 form?
Officially, any time after Oct 1, 2006.
When must I start using it?
You must use the new 1500 exclusively by April 1st, 2007. That is the "set in stone" deadline for everyone (providers and payers).
How do I know when my insurance payer is ready for them?
Good payers will advise you. But if they do not, you need to ask them for their acceptance date. We expect that most will be ready and operating by January 2007. We recommend waiting until their "deadline" date and not necessarily their "acceptance" date to ensure that your claims are processed correctly.
I heard that Medicare and others are accepting the new 1500 forms now. Shouldn't I be using them now?
No. Just because a payer is accepting the new 1500, does not mean that it is required. This is actually a testing period for them. Of course, if you like being the guinea pig, submit claims with the new forms early on. However, why not wait awhile, just to make sure the bugs are worked out of the system. We recommend starting in January.
Where can I get the new forms?
We carry the new claim forms. You can purchase them in our online store. Many other medical supply vendors also carry them.
What about my old forms?
You can use them until March 31st, 2007. Don't throw them away yet. You can still submit claims using the old form, up until April 1, 2007 for some third-party payors. Obviously, they can also be used as receipts for non-insurance (cash) patient encounters. And lastly, if it is long cold winter, have a nice bonfire.
Will there be problems in this transition?
Of course. For example, we have received notification that if you do use the new form, you need to make sure that you include your previous UPIN and/or GRP # on the form in addition to the NPI to avoid problems in processing your claim.
Do I really need to know the various starting dates for our payers?
It could be very helpful. Submitting a claim on the new form when they are not ready could delay payment.
Will my SOFTWARE work with the new 1500 form?
No. All software programs for printing onto the old CMS 1500 (HCFA 1500) claim form were designed long before HIPAA, the NPI and new 1500 Claim Form. Any software will need to be updated, in order to print onto the new layout.