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HCFA 1500 to CMS 1500 – Seven Big Changes

Alice Scott

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The standard HCFA 1500 (12-90) form that the medical profession has used for many years is now outdated and being replaced by the “new and improved” CMS 1500 (08-05) form. There are many differences in the two forms. Some language was removed, some changed, some added, and the size of many boxes was increased or decreased. Some of the boxes are split and some are shaded. HCFA 1500 to CMS 1500 - the seven big changes you will need to know about to properly complete a CMS 1500 form.

1. The new CMS 1500 accommodates the reporting of the NPI number. This is by far the most important change in the new form. The former locations for provider identification numbers are now split into two boxes with one half of the box shaded. The NPI number goes in the lower area of the proper box with the other ID numbers directly above in the shaded area of the split box.

2. The barcode was removed from the header. The barcode was removed to allow for a larger space in the header for the payer address information.

3. “Please do not staple in this area” was removed from the header. Medicare asks you to staple attachments to the top center of a single claim form.

4. “Tricare” was added above “Champus” in box 1.

5. “Type of Service” was removed from box 24C. This field is now called “EMG”. The NUCC states that feedback from the industry was that Type of Service was no longer required for a claim.

6. The field “Reserved for local use” was removed.

7. “NUCC Instruction Manual available at:” was added.

These are the biggest changes you will notice when you start completing the new CMS 1500 forms. Make sure you look them over carefully so you have a smooth transition from the HCFA 1500 to CMS 1500 forms.

Copyright 2007 Alice Scott

Alice Scott and her daugher/partner are co-owners of a medical billing service. They offer an informational website for both physician's offices and the general public looking for information or help with their problems on medical billing. For more information about what's new in Medical Insurance Billing, click here .


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