New CMS-1500 Claim Form Version 08/05

The National Uniform Claim Committee (NUCC) revised the CMS-1500 version 12/90 in the year 2006 and as a result from 1^st June 2007 it is stated that it is mandatory to report all claims on the revised 08/05 version of the form.

In compliance with the above mentioned revision, we have made provisions within INTELEC to include CMS-1500 Version 08/05.

You can access the CMS-1500 (08/05) form by pressing F4 from the "Insurance Information screen" (F16).

The *1500 in yellow indicates that you have CMS-1500 information.

The changes in INTELEC for CMS-1500(08/05) compared to CMS-1500 (12/90) are as follows:-

A new field for Referring Physician NPI (Provider NPI #) has been included. This is a ten digit number. Also a two digit space has been provided to accommodate Qualifier code (QUAL) next to Ref. Physician ID field. (Block 17b & 17a). The corresponding Porvider NPI# is in a different location, to the left of the Fac NPI#.

New fields to accommodate Service Facility NPI, Other ID & Qualifier code have been added. The space next to Other ID field is for the Qualifier code. (Block 32a & 32b)

The fields PIN# & GRP# in CMS-1500 Version 12/90 have been removed and new fields are added to accommodate Billing Provider NPI, Other ID & Qualifier code. The Qualifier is next to the Other ID field. (Block 33a & 33b)

Two more spaces have been added for Modifier Codes. The total number of spaces for Modifier Codes is now four. The first two Modifier Codes are on the 1^st CMS-1500 detail screen, you can access the second set of Modifier Codes by pressing F10. Even though this shows the data of the Modifier Codes of the first screen, you can enter data for the last two Modifier Codes in the same place as it will print on the form in its appropriate place. (Block 24D)

New fields for Provider NPI, Other ID & Qualifier code (QUAL) have been added. Qualifier field is next to Other ID field. You can access this by pressing F10 from the CMS-1500 screen. (Block 24I & 24J)

Printing data to CMS-1500 (08/05) form as a test

To print a CMS-1500 form you have to type "P" in the "Rebill" option.

Then press F12 to update. After that you have to execute the following program from your command line.

CALL PGM(ZPRTINSCL)

The above program will produce the CMS-1500 (08/05) form. We have created this for laser printers only.