First deadline for new claim form

The National Uniform Claim Committee, a volunteer organization of health care industry professionals, including the American Medical Association, has set a recommended Oct. 1 deadline for health plans to begin accepting the revised 1500 paper claim form.

The impetus for revising the form came with the HIPAA-required establishment of a new National Provider Identifier, which replaces plan-specific identifiers. The new form creates a line for the NPI.

But it also has 54 other changes. They range from removing the "Please Do Not Staple In This Area" order to various syntax changes -- such as changing "Diagnosis Code" to "Diagnosis Pointer" -- intended to clarify what services physicians have performed, and where.

Under the NUCC guidelines, from Oct. 1 to March 31, 2007, physicians can use either the current version or the revised version of the 1500 claim form. During this period, the NUCC advises physicians to check with third-party payers to make sure they are able to accept the revised form.

Humana, for example, has advised doctors that it will be ready to handle the new claim form soon after Oct. 1. But Medicare says it will not start accepting the new form until Jan. 2, 2007.

Beginning April 1, 2007, the current version of the 1500 claim form will be discontinued, the NUCC said. Generally, insurers, including Medicare, are expected to accept the new form even if a physician submits it with his or her old identifier code. But after May 23, 2007, plans will reject any claim without an NPI.

Mohit M. Ghose, spokesman for America's Health Insurance Plans, said some plans are waiting for more technical guidance from the Centers for Medicare & Medicaid Services about implementing the new NPI, but so far he's not aware of any problems that plans have encountered while working toward making the transition to the new NPI. He said while all plans may not follow the recommended October deadline, they will certainly meet the May 2007 deadline.