MIR-2007-5B, May 2007

Revisions to the CMS-1500 Form Submission Requirements

Provider Types Affected
Physicians, nonphysician practitioners, and suppliers who bill Medicare contractors (Part A/B Medicare Administrative Contractors (A/B MAC), carriers, durable medical equipment regional contractors (DMERCS) and DME Medicare Administrative Contractors (DME MAC) for their services using the Form CMS-1500.

Background
The CMS-1500 Form answers the needs of many health insurers. It is the basic form prescribed by the Centers for Medicare & Medicaid Services (CMS) for the Medicare and Medicaid programs for claims from physicians and suppliers. The language contained in the Medicare Claims Processing Manual, Chapter 26, regarding the CMS-1500 Form is being updated to reflect current processing guidelines and incorporate recent data collection decisions made by CMS.

Key Points
CR5489 makes the following updates to the CMS-1500 requirements:

• The requirement to submit the provider’s Social Security Number in Item 25 has been removed;
• The requirement to report the PIN of the Skilled Nursing Facility in Item 23 has been removed; and
• Clarification language was added to Item 17a, indicating the qualifier 1G precedes the Unique Physician Identification Number (UPIN).

In addition, language has been added regarding the completion of Item 25 (the provider of service or supplier federal tax identification number). Medicare providers are not required to complete this item for crossover claim purposes, since the Medicare contractor will retrieve the tax identification information from their internal provider file for inclusion on the Coordination of Benefits (COB) outbound claim. However, tax identification information is used in the determination of accurate National Provider Identification (NPI) reimbursement. Thus, reimbursement of claims submitted without tax identification information may be delayed.

Additional Information
CR5489 is the official instruction issued to your Medicare contractor. That instruction may be viewed by going to http://www.cms.hhs.gov/Transmittals/downloads/R1215CP.pdf on the CMS Web site. The revised Chapter 26, section 10.4, of the Medicare Claims Processing Manual is attached to CR5489.

If you have any questions, please contact your contractor at their toll-free number, which may be found at http://www.cms.hhs.gov/MLNProducts/downloads/CallCenterTollNumDirectory.zip on the CMS 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: MM5489
Pub. 100-4, Transmittal# R1215CP, CR# 5489
Related CR Release Date: March 30, 2007
Effective Date: April 1, 2007
Implementation Date: April 30, 2007

PQRI Information Available
A new CMS Web page dedicated to providing information on the Physician Quality Reporting Initiative (PQRI) is now available.

On December 20, 2006, the President signed the Tax Relief and Health Care Act of 2006 (TRHCA). Section 101 under Title I authorizes the establishment of a physician quality reporting system by CMS. CMS has titled the statutory program the Physician Quality Reporting Initiative. For more information, visit http://www.cms.hhs.gov/pqri on the CMS Web site.