As previously communicated, the National Uniform Claim Committee (NUCC) has approved an updated version of its 1500 Health Insurance Claim Form (CMS-1500 claim form). The new claim form (02/12), which went into effect January 6, 2014, accommodates reporting needs for ICD-10 and aligns with data captured on electronic 837 transactions. AmeriHealth now receives and processes paper claims submitted only on the new CMS-1500 (02/12) claim form. Any paper claims submitted using the old version of the form (08/05) will be rejected. To ensure proper claims submission, follow these tips:

1. A tax ID number is required on all submissions.
2. Legacy provider ID is optional and is prefixed with G2.
3. An NPI (National Provider Identifier) is a unique 10-digit identification number. There are no dashes in the NPI. There is no prefix with the NPI.
4. The following identifiers are not valid in the NPI field: tax ID number, Social Security number, corporate ID number.
5. Do not use the NPI for a physician as a billing NPI unless the physician is an individual/sole proprietor.
6. PIN and GROUP numbers should no longer be used on the CMS-1500 claim form.
7. Boxes 17a, 32b, and 33b require a G2 prefix.
8. Box 19 requires a ZZ prefix with the taxonomy code.
9. A referring provider is required on Specialty Pharmacy and Independent Clinical Laboratory claims submissions.
10. In field 21, diagnosis codes must be entered horizontally in the appropriate alpha order. There is an option of entering up to 12 diagnosis codes, starting in field A and continuing across through field L. Use the appropriate ICD Diagnosis Code Indicator: 9 = ICD-9.
11. Diagnosis Code Pointer is alpha (not numeric).
12. Ensure that all two-character qualifier IDs are used, as appropriate.

Resources available

For more information about the key changes that were made to the CMS-1500 claim form, please refer to the detailed article in the March 2014 edition of Partners in Health Update^SM. For claims submission addresses by product, please refer to our payer ID grids available on the EDI section of our website.To assist you in submitting claims using the new CMS-1500 (02/12) claim form, we have revised our CMS-1500 toolkit to reflect the updated version of the form. Download this toolkit, titled Claims submission toolkit for proper electronic and paper claims submissions.The NUCC has also published an updated 1500 Health Insurance Claim Form Reference Instruction Manual, which is available under the 1500 Claim Form tab on the NUCC website.If you have any questions, please contact your Network Coordinator or Hospital/Ancillary Services Coordinator.