REVISED CMS-1500 CLAIM FORM

Date:   10/11/2006

On July 21, 2006 The National Uniform Claim Committee (NUCC) released the revised 1500 claim form, which accommodates the National Provider Identifier (NPI). The Revised CMS 1500 form allows 6 service lines only. In accordance with these changes Infinedi will process a maximum of 6 service lines and 1 comment line per service line.

Effective 10/18/06 Infinedi will reject claims that contain more than 6 service lines if you submit claims using the Revised CMS 1500 format.

Effective 11/15/06 Infinedi will reject claims that contain more than 6 service lines if you submit claims using the old or Revised 1500 format.

Provider Action:

If your Practice Management System is set up to print more that 6 service lines, please contact your software support for instructions on how to total and save the claim after 6 service lines are entered. For more information on changes made to the CMS 1500 please visit the NUCC website at www.nucc.org

Sample Service Line Section of Revised CMS 1500