Reminder – Two New Claims Forms Being Implemented Soon

As we advised previously, the new 1500 Health Insurance Claim Form and the UB-04 form are required for paper claims submissions beginning January 1, 2008.

CMS-1500

The Centers for Medicare & Medicaid Services (CMS) delayed their implementation of the new 1500 claim form from April 1, 2007 until January 1, 2008. TRICARE is following CMS’ lead; therefore the new form is required for all claims submitted to TriWest beginning January 1, 2008, regardless of the date of service.

Information regarding the new version of the CMS 1500 is posted on the National Uniform Claim Committee (NUCC) Web site at http://www.nucc.org/ along with documents related to the release of the revised version of the form, including: a Reference Instruction Manual; change log; and FAQs. The 1500 claim form was revised to accommodate the reporting of the National Provider Identifier (NPI) Number.

UB-04

The National Uniform Billing Committee (NUBC) is replacing the CMS-1450 form (also known as the UB-92) with the UB-04 form. The UB-04 form is used by hospitals and other institutional providers to bill government and commercial health plans. The UB-04 must be used exclusively for institutional billing beginning January 1, 2008 for TRICARE claims.

The UB-04 data set accommodates the NPI and incorporates a number of other important changes and improvements. It also will be Health Insurance Portability and Accountability Act of 1996 (HIPAA) compliant.

According to the TRICARE Operations Manual, Chapter 8, Section 4, paragraph 10.0, the signature of the non-network provider, or an acceptable facsimile, is required on all participating claims.

The provider’s signature block Form Locator (FL) has been eliminated fromthe CMS 1450 UB-04. As a work around, the National Uniform Billing Committee (NUBC) has designated FL 80, Remarks, as the location for the signature, if signature-on-file requirements do not apply to the claim. If a non-network participating claim does not contain an acceptable signature, the claim will be returned.

Further information on the UB-92 and the UB-04, an instruction manual for subscribers, and the forms are available for purchase at http://www.nubc.org/.