Wednesday, August 12, 2015

New field qualifiers on 17

CMS 1500 Claim Form Instructions: Revised for Form Version 02/12

Form Version 02/12 will replace the current CMS 1500 claim form, 08/05, effective with
claims received on and after April 1, 2014:
• Medicare will begin accepting claims on the revised form, 02/12, on January 6,2014;
• Medicare will continue to accept claims on the old form, 08/05, through March 31,2014;
• On April 1, 2014, Medicare will accept paper claims on only the revised CMS 1500claim form, 02/12; and
• On and after April 1, 2014, Medicare will no longer accept claims on the old CMS1500 claim form, 08/05.

The National Uniform Claim Committee (NUCC) recently revised the CMS 1500 claim form. On June 10, 2013, the White House Office of Management and Budget (OMB) approved the revised form, 02/12. The revised form has a number of changes. Those most notable for Medicare are new indicators to  ifferentiate between ICD-9 and ICD-10 codes on a claim, and qualifiers to identify whether certain  roviders are being identified as having performed an ordering, referring, or supervising role in the furnishing f the service. In addition, the revised form uses letters, instead of numbers, as diagnosis code pointers, and
expands the number of possible diagnosis codes on a claim to 12.

The qualifiers that are appropriate for identifying an ordering, referring, or supervising role
are as follows:
• DN - Referring Provider
• DK - Ordering Provider
• DQ - Supervising Provider

Providers should enter the qualifier to the left of the dotted vertical line on item 17.

The Administrative Simplification Compliance Act (ASCA) requires Medicare claims to be sent electronically unless certain exceptions are met. Those providers meeting these exceptions are permitted to submit their claims to Medicare on paper. Medicare requires that the paper format for professional and supplier paper claims be the CMS 1500 claim form. Medicare therefore supports the implementation of the CMS 1500 claim form and its revisions for use by its professional providers and suppliers meeting an ASCA exception.

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