Instructions Regarding

the Use of the new HCFA 1500 Form

and your NPI Numbers

To start using the new NPI numbers, you must first begin using the new CMS-1500 form – Version 08/05.   The new claim form was specifically designed to allow all insurance companies to accept the NPI numbers. The NPI numbers will replace other provider identifiers previously used by health care providers that were assigned by payers. (Examples of Provider identifiers are your BCBS ID #, UPIN number, Medicare number, etc).

New CMS HCFA 1500

NPI Number "Fact Summary"

January 1, 2007.  Insurance companies began accepting the new CMS HCFA 1500 form.

January 1 - April 2, 2007  Transitional Phase.

During the transitional phase, you may begin using the new HCFA 1500 form but you must include BOTH your NPI number(s) and, if there is one, the appropriate provider identifier number, such as your BCBS ID #. 

May 31, 2007

After May 31, 2007, insurance companies will ONLY accept the new HCFA 1500 form.  Any paper claims submitted to CNC after this date must be submitted on the new HCFA 1500.

June 1, 2007

Beginning June 1, 2007, all PAPER claims mailed to CNC, must have your NPI number(s) in the correct boxes.

CHANGES TO THE CMS HCFA 1500 FORM

Please note the following changes to the New CMS-1500 form Version 08/05.

Please follow these instructions carefully regarding the proper completion of the new HCFA 1500 form and the use of your NPI number(s).

1. Box 17 (Referring physician).

For claims sent to CNC, Box 17(referring provider) should only be completed if you are billing an E/M consultation code.  The use of these consultation codes are limited to those services performed when another provider referred the patient to you for evaluation and/or management of a specific problem and specifically requested the consultation.

Notice that Box 17a is now split into two sections: 17a & 17b. If you are completing box 17, then box 17b should be completed with the referring provider’s NPI number.  Box 17a is only required if the NPI number is not reported in box 17b. In such a case, then box 17b must contain the referring provider’s provider identifier, such as his/her BCBS ID #.

BCBSNC requires the use of their BCBS ID Qualifier (1B) in the shaded area and to the immediate right of 17a. Enter the BCBSNC ID number of the referring provider in the shaded box to the right of the ID Qualifier.”

2. Box 24 (Service lines)

 Box 24 (continued)

Please note that box 24 has a few changes. One is the elimination of the current box 24c “Type of Service” and box 24J “COB” These boxes have been eliminated and are no longer reported on the new CMS forms.

Your Type 1 NPI number must be entered in box 24J in the non-shaded area. During the transitional period, IF APPLICABLE, you must  also enter your proprietary identifier in the shaded area as well as your Type 1 NPI number in the non-shaded area. For example, enter the assigned BCBSNC ID number for the performing Provider in the shaded area and enter the Type 1 NPI number of the performing provider below the dotted line.

 3. Boxes 32 and 33 (Service Facility & Billing Provider Information)

Please note that both Box 32a and 33a indicate where you must place your NPI number and are appropriately labeled “NPI” on the form.  Your Type 2 NPI number must be entered in BOTH of these boxes. If you do not have a Type 2 NPI number, you MUST enter your Type 1 NPI number in both of these boxes. During the transitional phase, your provider identifiers (such as your BCBS ID #) must also be placed in boxes 32b & 33b.

The insurance companies and CNC will accept the new CMS-1500 forms as well as the old HCFA 1500 forms until April 2, 2007.  After that date,

Please contact your CNC Provider Representative if you have additional questions about these changes.  We are happy to help!

 To obtain your NPI numbers, please go to the NPPES website below to fill out your NPI application(s)

https://nppes.cms.hhs.gov/NPPES/Welcome.do