PRACTICE BULLETIN

Implementation  Plans For The Revised CMS-1500 Form Announced 

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

December 2006

The Centers for Medicare and Medicaid Services (CMS) recently announced implementation plans for the revised CMS-1500 Form, formerly known as HCFA-1500.  The form is commonly used by clinical social workers and other providers who are excluded from the mandatory electronic claims submission requirements and submit paper claims to Medicare carriers.  The CMS-1500 Form is also the most frequently used reimbursement form requested by other third-party payers for paper claim submissions by clinical social workers and other providers who render health and mental health services in outpatient settings.

The National Uniform Claim Committee (NUCC) revised the form to accommodate the new National Provider Identifier (NPI).  NASW participated in the revision process.  CMS is implementing the revised CMS-1500 Form and has released the following timeline to transition to the revised version:

• January 1, 2007

Clinical social workers may begin using the revised CMS-1500 Form

• January 2, 2007 - March 30, 2007

During this transition period, providers can use either the current version of the CMS-1500 Form or the revised version.

• April 2, 2007

The revised CMS-1500 Form will be mandated for use and the old version will be discontinued.  All rebilling of claims should be resubmitted on the revised CMS-1500 Form even though earlier submissions may have been on the old form.  Lack of adherence to this implementation date may result in payment denials.  

Clinical social workers who are in independent practice and seek reimbursement from a health plan should contact the health plan prior to submitting a claim on the revised form to ensure that the plan is prepared to accept it for processing.  NASW will keep its members abreast of this issue and inform them of any changes in the implementation plans.

Additional information about the changes and implementation plans for the CMS-1500 Claim Form is available at:
NUCC Web site: http://www.nucc.org/
CMS Web site:  http://www.cms.hhs.gov/