PRACTICE BULLETIN

Revised CMS-1500 Claim Form Coming

Mirean Coleman, MSW, LICSW, CT
Senior Policy Associate for Clinical Social Work

For the first time since 1990, clinical social workers and other providers who seek reimbursement soon will be required to use a new version of the CMS-1500 Claim Form.   Formerly known as HCFA-1500, the CMS-1500 is commonly used to submit claims for reimbursement of health and mental health services.  Revisions are being made by the National Uniform Claim Committee (NUCC) to accommodate the new National Provider Identifier (NPI) and were announced in the Federal Register on February 24, 2006 with a 30-day comment period.  The revised version is currently under review pending final approval by the Office of Management and Budget (OMB).  NASW participated in the review process through the NUCC.

NUCC is recommending the following proposed  timeline to transition to the revised version of the CMS-1500.

• October 1, 2006
  Health plans, clearinghouses, and other vendors should be ready to handle and accept the revised CMS-1500 Claim Form.
• October 1, 2006 – February 1, 2007
  Providers can use either the current version or the revised version of the CMS-1500 Claim Form.
• February 1, 2007
  The current version of the CMS-1500 Claim Form is discontinued and only the revised form is to be used.  All rebilling of claims should only use the revised form even though earlier submissions may have been on the current discontinued form.  A February 2007 transition is being recommended to ensure the functioning of the revised form prior to the May 23, 2007 deadline for the reporting of the NPI.

Clinical social workers who are in independent practice should contact a health plan prior to submitting a claim on the revised form to ensure that it is prepared to accept it.  Once the new CMS-1500 Claim Form is implemented, claims submitted on the current CMS-1500 form will be automatically rejected.  NASW will keep its members abreast of this issue and inform them of final implementation plans.

Additional information about the changes to the CMS-1500 Claim Form is available at the NUCC Web site at http://www.nucc.org/