April 2007

Update: CMS-1500 Claim Form Information

The Centers for Medicare & Medicaid Services (CMS) has notified Medi-Cal that there were incorrectly formatted versions of the revised CMS-1500 claim form being sold by print vendors, specifically the Government Printing Office (GPO). After reviewing the situation, the GPO has determined that the source files it received from the National Uniform Claim Committee’s (NUCC) authorized forms designer were improperly formatted. The error resulted in the sale of both printed forms and negatives, which do not comply with the form specifications. However, not all of the new forms are incorrect.

The following will help to properly identify whether providers have a version of the form that needs to be updated. The old version of the form contains “Approved OMB-0938-0008 FORM CMS-1500 (12-90)” on the bottom of the form, typically located in the lower right corner, signifying it is the December 1990 version. The revised version contains “Approved OMB-0938-0999 FORM CMS-1500 (08-05)” on the bottom of the form, signifying it is the August 2005 version.

Checking the information at the upper right hand corner of the form is the best way to identify if that particular version is correct. On properly formatted claim forms, there will be an approximate ¼-inch gap between the tip of the red arrow above the vertically stacked word “CARRIER” and the top edge of the paper. If the tip of the red arrow is touching or close to touching the top edge of the paper, then the form is not printed to specifications.

New FAQs Posted
CMS has posted new NPI FAQs on its Web site. To find the latest FAQs, click the arrows next to “Date Updated.”