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MIR-2007 04B, April 2007
MLN Matters. . .Information for Medicare Providers
(Issued by the Centers for Medicare & Medicaid Services)
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Extension for Acceptance of the CMS-1500 Form (12-90) (CR5568)
Provider Types Affected
Physicians, nonphysician practitioners, and suppliers who submit claims for their services using the CMS-1500 form to Medicare contractors (carriers, Part A/B Medicare Administrative Contractors (A/B MAC), durable medical equipment regional carriers (DMERC), and/or DME Medicare Administrative Contractors (DME/MAC))
Be aware that some of the new CMS-1500 (08-05) forms have been printed incorrectly. This article contains details on this issue.
Background
The CMS-1500 form is one of the basic forms prescribed by the Centers for Medicare & Medicaid Services (CMS) for the Medicare program. It is only accepted from physicians and suppliers that are excluded from the mandatory electronic claims submission requirements set forth in the Administrative Simplification Compliance Act, Public Law 107-105 (ASCA), and the implementing regulation at 42 CFR 424.32. The CMS-1500 form (12-90) was revised in July of 2006 to accommodate the reporting of the National Provider Identifier (NPI).
Recently it came to the attention of CMS that there are incorrectly formatted versions of the revised form being sold by print vendors. After reviewing the situation, CMS determined that the source files received from the authorized forms designer were improperly formatted. This resulted in the sale of printed forms and negatives which do not comply with the form specifications.
Therefore, CMS has decided to extend the acceptance period of the CMS-1500 form (12-90) version beyond the original April 1, 2007 deadline while this situation is resolved. The specific formatting issue involves top and bottom margins only, but may not be isolated to only top and/or bottom.
Key Points of CR5568
- CR5568 states that the CMS-1500 form (12-90) will continue to be accepted until CMS instructs otherwise.
- All CMS-1500 (08-05) forms received by Medicare contractors that are incorrectly formatted will be returned to the provider or supplier if the Medicare contractor is unable to scan the form with its Optical Character Reader scanning equipment. An incorrectly formatted form is one that is one-quarter inch or more off in the top, bottom, right, and/or left margins.
- The best way to identify the incorrect forms is by looking at the upper right hand corner of the form. If the tip of the red arrow above the vertically stacked word “CARRIER” is touching or close to touching the top edge of the form, then the form is not printed to specifications. There should be approximately one-quarter inch between the tip of the arrow and the top edge of the paper on properly formatted forms.
- Providers submitting the CMS-1500 (12-90) are only required to submit their legacy provider number on that form, since the CMS-1500 (12-90) cannot accommodate the NPI. It is important to note that this issue involves the paper claim form only, not the electronic claim format, which can accommodate the NPI. In addition, this situation does not affect the current NPI implementation date of May 23, 2007.
Additional Information
To see the official instruction (CR5568) issued to your Medicare carrier, A/B MAC, DME MAC, or DMERC, go to http://www.cms.hhs.gov/Transmittals/downloads/R1208CP.pdf  on the CMS Web site.
To view the original communication from CMS regarding this issue, visit http://www.cms.hhs.gov/ElectronicBillingEDITrans/downloads/1500%20problems.pdf on the CMS site.
If you have questions, please contact your Medicare carrier, A/B MAC, DME MAC, or DMERC at their toll-free number which may be found at: http://www.cms.hhs.gov/MLNProducts/downloads/CallCenterTollNumDirectory.zip  on the CMS Web site.
Disclaimer
This article was prepared as a service to the public and is not intended to grant rights or impose obligations. This article may contain references or links to statutes, regulations, or other policy materials. The information provided is only intended to be a general summary. It is not intended to take the place of either the written law or regulations. We encourage readers to review the specific statutes, regulations and other interpretive materials for a full and accurate statement of their contents
MLN Matters Number: MM5568
Pub. 100-4, Transmittal# R1208CP, CR# 5568
Related CR Release Date: March 19, 2007
Effective Date: April 1, 2007
Implementation Date: April 2, 2007
Do you have your NPI? National Provider Identifiers (NPIs) will be required on claims sent on or after May 23, 2007. Every health care provider needs to get an NPI. Learn more about the NPI and how to apply for an NPI by visiting http://www.cms.hhs.gov/NationalProvIdentStand/  on the CMS Web site.
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