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.

Timeline for implementing new claim form (02/12)

AmeriHealth will enforce the following NUCC-approved transition timeline for the CMS-1500 (02/12) claim form:

• January 6, 2014: AmeriHealth began receiving and processing paper claims submitted on the newCMS-1500 (02/12) claim form.
• January 6 ? March 31, 2014: Dual-use period during which AmeriHealth will continue to receive and process paper claims submitted on the old CMS-1500 (08/05) claim form or on the revised CMS-1500 (02/12) claim form.
• April 1, 2014: AmeriHealth will receive and process paper claims submitted only on the new CMS-1500 (02/12) claim form.

Key changes to the CMS-1500 (02/12) claim form

There are some notable differences between the original version (08/05) and the new version (02/12) ofthe CMS-1500 claim form, including the following:

• Field 21:
  – The most significant change, which may require your office to make system changes, is that Field 21 nowaccommodates up to 12 diagnosis codes. These codes must be entered beginning in field A and thenhorizontally across the fields through field L, as shown in the example below. CMS-1500 (02/12) claim formssubmitted incorrectly may be rejected or returned to the provider.
• Correct
  
• Incorrect
  
• – This field now includes an ICD diagnosis code indicator. As shown in the example below, use a "9"for ICD-9 codes. Once ICD-10 codes go into effect on October 1, 2014, use a "0" in this field.
  
• Field 24E: The Diagnosis Code Pointer on the new version (02/12) is now alphabetic and no longer numeric.
• Fields 24l, 32b, and 33b: The provider?s two-character qualifier has been changed to G2

Updated CMS-1500 toolkit and other resources

To assist you in submitting claims using the new CMS-1500 (02/12) claim form, we have revised our CMS-1500toolkit to accommodate the updated version of the form. Download the toolkit, titled Claims submission toolkitfor proper electronic and paper claims submissions. This toolkit contains the latest information on electronic and paper claims submissions, asample CMS-1500 (02/12) claim form, key fields, loop and data elements, and resources for finding additionalinformation.

In addition, the NUCC has published an updated 1500 Health Insurance Claim Form Reference Instruction Manual,which is available under the 1500 Claim Form tab on the NUCC website.

CMS-1500 (02/12) claim forms can be purchased through office supply stores, local printing companies, or bycalling the U.S. Government Printing Office at 1-866-512-1800.

For claims submission addresses by product, please refer to our payer ID grids, which are available atElectronic Data Interchange page on our website.

If you have any questions, please contact your Network Coordinator or Hospital/Ancillary Services Coordinator.