MVP Health Care has developed this guide to help orient you to the key data fields that are changing on the new CMS-1500 Paper Claim Form that will be accepted by MVP Health Care starting 10/1/06 and mandatory beginning 4/1/07. The following example illustrates the changes between the HCFA-1500 claim form and the MVP Health Care data requirements on the new CMS-1500 paper claim form.
MVP Health Care Data Field Changes on CMS-1500 Paper Claim Form
CMS- 1500 Box Submission Requirement
Box 24a-h Shaded Lines Use the shaded lines above the service lines for: Anesthesia start/stop times Other service line information ( e.g. descriptions for unspecified codes )
Box 24i* Use the shaded space above “NPI” to report qualifier ZZ when reporting Rendering Taxonomy in the shaded space in the top half of Box 24j
Box 24j* Use the shaded space above the NPI to report Rendering Taxonomy
Box 33a NPI
Box 33b Taxonomy code (preceded by ZZ qualifier)