CLINICAL  SOCIAL  WORK  PRACTICE  BULLETIN

Delayed Implementation Date For Revised CMS-1500 Form

Mirean Coleman, MSW, LICSW, CT
Senior Policy Associate
May 2007

The Centers for Medicare and Medicaid Services (CMS) recently extended the implementation date for the revised CMS-1500 Form from April 1, 2007 to the targeted date of June 1, 2007. The CMS-1500 Form is the most frequently used reimbursement form by clinical social workers and other providers who perform health and mental health services in outpatient settings. The extension in implementation is due to the distribution of incorrectly formatted versions of the revised CMS-1500 Form sold by the Government Printing Office.

To correct the problem, contractors who process Medicare claims have been instructed by CMS to return to clinical social workers and other providers any submitted revised CMS-1500 Forms that have not been printed to specifications.

Identifying the Incorrect Form
The old version of the CMS-1500 Form has written on the bottom of the form in the lower right-hand corner: “Approved OMB-00938-0008 Form CMS-1500 (12-90).” The revised version contains on the lower right-hand corner of the form: “Approved OMB-0938-0999 Form CMS-1500 (08-05).”   The best way to identify whether a revised CMS-1500 Form is correct is to examine the upper right-hand corner of the form. There should be a one-fourth inch gap between the stacked word “CARRIER” and the top edge of the paper. If the tip of the red arrow is touching or close to the top edge of the CMS-1500 Form, then the form does not meet specifications and should not be used.

Should You Have the Incorrect Form
If you have identified an incorrect CMS-1500 Form in your possession, you should take the following steps:

1. Immediately stop using it.
2. Return it to the vendor from whom you purchased it and request the corrected, revised form.
3. Continue to use the CMS-1500 form until June 1, 2007 if you are unable to locate the corrected, revised form.
4. Returned claims from the contractor on the incorrect form may be resubmitted on the old form until June 1, 2007 or resubmitted on the corrected, revised form

NASW will keep its members abreast of new information about the CMS-1500 Form as it is made available from CMS. Additional information about the implementation of the CMS-1500 Form is available at:
National Uniform Claim Committee Web site: http://www.nucc.org/
CMS Web site:  http://www.cms.hhs.gov/