NPI: New Claim Form Submission Reminders
August 3, 2007
The following are reminders for correctly submitting the new CMS-1500 and UB-04 claim forms:
- Claim forms must be printed on scanner-quality paper. Forms printed on low-quality or thin paper are not acceptable, as they tear easily during the scanning process.
- Original claim forms must be submitted. Copies will not be accepted.
- All provider information fields must be completed.
- Claim information must be properly entered within the borders of the appropriate area or box. Claims with the information in the middle or outside of a border may be rejected.
The following are reminders specific to the CMS-1500 claim form:
- CMS-1500 claim forms with bar codes are not acceptable.
- The Medi-Cal provider number must be entered in Box 33B
through November 25, 2007. Claims without the
Medi-Cal provider number in Box 33B will not be processed. The National Provider Identifier (NPI) should be entered in Box 33A. Beginning November 26, 2007, the NPI will be the only identifier accepted on claim forms, and it must be entered in Box 33A.
Note: The only exceptions to the NPI requirement are atypical providers (blood banks, Christian Science practitioners, and Multipurpose Senior Services Program providers).
The following are reminders specific to the UB-04 claim form:
- Code 001 should be entered on line 23 of field 42. The
total charges amount should be entered on line 23 of
field 47. - In the Payer Name field (Box 50), either “O/P MEDI-CAL” or “I/P MEDI-CAL” must be entered, depending on the type of service being billed.
- The Medi-Cal provider number must be entered in Box 57 through November 25, 2007. The Health Plan ID field (Box 51) is not the correct field for the Medi-Cal provider number. Claims without the Medi-Cal provider number in Box 57 will not be processed. The NPI should be entered in Box 56. Beginning November 26, 2007, the NPI will be the only identifier accepted on claim forms, and it must be entered in Box 56.
Note: The only exceptions to the NPI requirement are atypical providers (blood banks, Christian Science practitioners, and Multipurpose Senior Services Program providers).