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MIR-2006-10AB, October 2006

Revised CMS-1500 Claim Form

The MLN Matters Article MM4293 was posted to Empire Medicare Services’ Web site on April 12, 2006. Please note that the time line for new Form-1500 (08/05) provided within this article is superseded by the time line provided in MM5060, which was posted to the News section of our Web site on August 7, 2006. MM4293 has been revised to include the following Note:

Note: This article was revised on August 25, 2006, by adding this statement directing readers to view article MM5060 at http://www.cms.hhs.gov/MLNMattersArticles/downloads/MM5060.pdf for more current information on the effective dates for using Form CMS-1500 (08/05). The dates in the MM5060 article supersede the dates in this article, and MM5060 conforms to CR5060, which is available at http://www.cms.hhs.gov/transmittals/downloads/R1010CP.pdf .