Magellan Health Services
Provider Focus Newsletter
News & information for Magellan network providers

Columns : Claims Today

Revised CMS-1500 Form Implemented

Magellan is committed to keeping you informed of relevant updates that could impact your daily practice.

In August 2013, the Centers for Medicare & Medicaid Services (CMS) approved an updated version of the Health Insurance Claims Form – the CMS-1500 paper claim form (version 02/12) for implementation beginning Jan. 6, 2014. We currently are in a “grace period” in which both the old form (version 08/05) and new form (version 02/12) will be accepted. However, effective April 1, 2014, providers only can submit claims using the new CMS-1500 version 02/12 form.

The National Uniform Claim Committee (NUCC) maintains the CMS-1500 form and instructions. According to the NUCC CMS-1500 webpage1, the revised CMS-1500 form accommodates reporting needs for ICD-10 and aligns with requirements in the Accredited Standards Committee X12 (ASC X12) Health Care Claim: Professional (837P) Version 5010 Technical Report Type 3.

As listed on its site, the NUCC approved the following transition timeline at its in-person meeting in Chicago on Aug. 1, 2013.

  • Jan. 6, 2014: Payers begin receiving and processing paper claims submitted on the revised 1500 Claim Form (version 02/12).
  • Jan. 6 through March 31, 2014: Dual use period during which payers continue to receive and process paper claims submitted on the old 1500 Claim Form (version 08/05).
  • April 1, 2014: Payers receive and process paper claims submitted only on the revised 1500 Claim Form (version 02/12).

A crosswalk (change log) between the 1500 Claim Form 08/05 version and the 02/12 version as well as an instruction manual also can be found on the NUCC CMS-1500 webpage.

 

  1. http://nucc.org/

*Some Magellan Care Management Centers listed above may manage services for healt h plan, employer and public sector customers not located in the same geographic area as the service center. Check the state listings in parentheses to be sure you’re reading all the information pertinent to you in serving your Magellan members.

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