New procedures for the administration of the National Provider Identifier on Form CMS-1500 are included in this proposed change. The new processing instructions for CMS-1500 have also been added. 2. INTRODUCTION: In the previous versions of the form, the NPI was listed in the claim code box, and the claim data would be processed on the following day. The updated model, where NPI is now listed as Claim Code 602.01, will apply to Form 602 and all subsequent claims using the current version of form CMS-1500. The following changes have been made to the form. 2.1 The NPI will be in bold type under the 'Categories' heading. [Note: The new model form has blank boxes for items that cannot be processed by current CMS rules. These items include, for example, item Code 901 “Awards for Services, Gifts or Other Reimbursements Not Delivered or Not Used as a Claim.” Also, the new model would be used for claims for Services Received after July 31, 1996. See the Form 602 revision notice for further information. We will not be requiring any additional documentation if processing is made on the new form. However, it is still important when processing the current form that you have a copy of the claim for the service received in its original form.] 2.2 Item Code 602.01 will be located in the “Claim Text” area of the National Form 5500.2. This change is intended to keep the NPI in plain type rather than bold and would allow you to see any highlighted text in bold font. 2.3 Item Code 901 was added to describe the type of activity or service that was to be included in the statement for the National Provider Identifier (in bold font). 2.3.1 When a health or medical service received by the client after June 30, 1996, is included in the medical claims record, it has been changed to item Code 602.01 in order to conform to the form CMS-1500. 2.4 A new box was added to item Code 710, “Additional Costs”, indicating whether the claim for which the fee for the item will be paid will be reported as a deductible or as a previously deducted amount. 2.5 Items in Chapter 26 which have been changed to new chapter codes are noted to the left of the original chapter code. A table listing the current chapter codes is located at the bottom of the original chapter list. 3.
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CMS Manual System Pub 100-04 Medicare Claims Processing Transmittal 899 Department of Health & Human Services (HHS) Centers for Medicare & Medicaid Services (CMS) Date: MARCH 31, 2006, Change Request
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