New CMS 1500 Form

Screenshot of new CMS 1500

Screenshot of new CMS 1500

The old form will be available to view or print for any claims filed through March 31, 2014, and SOAPware will automatically switch to the new CMS 1500 form April 1, 2014.

Resubmitting claims that have to be filed on the old form after April 1, 2014 can be printed on the CMS1500 available in the patient's chart in the Billing Statement section.

Changes for the new form

Some of the information he new CMS 1500 has changed. Below is a list of some of the changes.

Item Number 8 Deleted “PATIENT STATUS” and content of field. Changed title to “RESERVED FOR NUCC USE.”

 

Item Number 9b Deleted “OTHER INSURED’S DATE OF BIRTH, SEX.” Changed title to “RESERVED FOR NUCC USE.”

 

Item Number 9c Deleted “EMPLOYER’S NAME OR SCHOOL.” Changed title to “RESERVED FOR NUCC USE.”

 

Item Number 10d Changed title from “RESERVED FOR LOCAL USE” to “CLAIM CODES (Designated by NUCC).”

Item Number 11b Deleted “EMPLOYER’S NAME OR SCHOOL.” Changed title to “OTHER CLAIM ID (Designated by NUCC).”

Added dotted line in the left-hand side of the field to accommodate a 2-byte qualifier.

 

Item Number 11d Changed “If yes, return to and complete Item 9 a-d” to “If yes, complete items 9, 9a, and 9d.”

 

Item Number 14 Changed title to “DATE OF CURRENT ILLNESS, INJURY, or PREGNANCY (LMP).” Removed the arrow and

text in the right-hand side of the field. Added “QUAL.” with a dotted line to accommodate a 3-byte qualifier.

Item Number 15 Changed title from “IF PATIENT HAS HAD SAME OR SIMILAR ILLNESS. GIVE FIRST DATE” to “OTHER

DATE.” Added “QUAL.” with two dotted lines to accommodate a 3-byte qualifier.

 

Item Number 17 Added a dotted line in the left-hand side of the field to accommodate a 2-byte qualifier.

 

Item Number 19 Changed title from “RESERVED FOR LOCAL USE” to “ADDITIONAL CLAIM INFORMATION (Designated by

NUCC).”

 

Item Number 21 Changed instruction after title from “(Relate Items 1, 2, 3 or 4 to Item 24E by Line)” to “Relate A-L to service

line below (24E).”

 

Item Number 21 Removed arrow pointing to 24E.

 

Item Number 21 Added “ICD Ind.” and two dotted lines in the upper right-hand corner of the field to accommodate a 1-byte

indicator.

 

Item Number 21 Added 8 additional lines for diagnosis codes. Evenly spaced the diagnosis code lines within the field.

 

Item Number 21 Changed labels of the diagnosis code lines to alpha characters (A – L).

 

Item Number 21 Removed the period within the diagnosis code lines.

 

Item Number 22 Changed title from “MEDICAID RESUBMISSION” to “RESUBMISSION.”

 

Item Number 30 Deleted “BALANCE DUE.” Changed title to “Rsvd for NUCC Use.”

 

Footer Changed “APPROVED OMB-0938-0999 FORM CMS-1500 (08/05)” to “APPROVED OMB-0938-1197 FORM

1500 (02/12).”

 

 

 

Changes to data entry in SOAPware for new form

1. Medicaid Resubmission Block 22. Changed to Resubmission Code and Original Reference Number. Medicaid Resubmission has been removed from More Info->Misc Details tab->Medicaid Resubmission Number, and should now be entered in More Info->Misc Details tab->Original Reference Number.

2. Employer's Name or School 11b. Changed title to “OTHER CLAIM ID (Designated by NUCC). Click to open Property And Casualty tab. Type Other Claim ID. The Y4 ID qualifier will default onto the claim when something is added to this field.