There seems to be a lot of changes in the world of medical billing and here comes another one! The classic red and white HCFA 1500 form is soon to be outdated. It won’t be anything drastic- just a few small changes. The HCFA 1500 will be obsolete and the new replacement is called the CMS 1500.

The CMS 1500 was revised in August of 2006. The revised form accommodates the reporting of the NPI number, or the National Provider Identifier. The new form will be accepted starting January 1, 2007 and its use is mandated by April 2, 2007. Both the old HCFA 1500 and the new CMS 1500 will be accepted between January 1, 2007 and April 2, 2007. After April 2, 2007, the old form will no longer be accepted.

The major difference between the HCFA 1500 and the CMS 1500 is the split provider identifier field which allows for the reporting of both the NPI Number and the corresponding Legacy Number. Claims submitted after May 23, 2007 will be denied if they do not have the NPI Number on them.

So if you submit any paper claims, you will want to start checking into the changes that you will need to make. Does your software have an update available that will accommodate the NPI Number and the new CMS 1500 form?

When billing medical insurance claims electronically, you’ll want to make sure your software and vendor are capable of reporting the NPI Number in the proper format.

I would strongly urge you not to wait until anywhere near the deadline to make sure you are ready for these changes. Start looking into the modifications now, and begin to make your plans for your office. If you wait until the last minute it could greatly disrupt your cash flow.

Copyright 2006 Michele Redmond
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