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REVISED CMS 1500 PAPER CLAIM FORM: VERSION 02/ 12

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REVISED CMS 1500 PAPER CLAIM FORM: VERSION 02/ 12

APPROVED OMB-0938-1197 FORM 1500 (02-12) 1a. INSURED’S I.D. NUMBER (For Program in Item 1) 4. INSURED’S NAME (Last Name, First Name, Middle Initial)

http://www.nucc.org/%5Cimages%5Cstories%5CPDF%5C1500_claim_form_2012_02.pdf

Date added: October 12, 2013 - Views: 80

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Change Request 8509 - Centers for Medicare and...

CMS Manual System Department of Health & ... SUBJECT: Form CMS-1500 Instructions: Revised for Form Version 02/12.

http://cms.gov/Regulations-and-Guidance/Guidance/Transmittals/Downloads/R2842CP.pdf

Date added: February 13, 2014 - Views: 5

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CMS- 1500 (version 02- 12) Claim Form...

Updated 05/18/2015 CMS-1500 (02-12) Claim Form Instructions pv11/18/2014 ii Change history Date (mm/dd/yyyy) Description of changes Impact 02/10/2014 Initial version

http://www.medicaid.nv.gov/Downloads/provider/NV_Billing_1500_Version_02-12.pdf

Date added: March 12, 2014 - Views: 21

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CMS 1500 (02/12) CLAIM FORM INSTRUCTIONS - Rhode...

PR0029 V1.3 07/16/14 CMS 1500 (02/12) CLAIM FORM INSTRUCTIONS FIELD NUMBER FIELD NAME INSTRUCTIONS 1 a INSURED’S ID NUMBER Enter the patient’s nine digit ...

http://www.eohhs.ri.gov/Portals/0/Uploads/Documents/cms1500_directions.pdf

Date added: December 5, 2013 - Views: 6

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CMS 1500 Claim Form Instructions: Revised for...

CMS 1500 Claim Form Instructions: Revised for Form Version 02/12 . Note: This article was revised on October 6, 2014, to reflect the revised CR8509 issued on

http://www.cms.gov/Outreach-and-Education/Medicare-Learning-Network-MLN/MLNMattersArticles/downloads/MM8509.pdf

Date added: March 12, 2014 - Views: 3

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CMS 1500 02-12 Claim Form Manual - NUCC

Version 1.1 06/13 . National Uniform Claim Committee . 1500 Health Insurance Claim Form . Reference Instruction Manual . for Form Version 02/12 . June 2013

http://www.nucc.org/%5Cimages%5Cstories%5CPDF%5C1500_claim_form_instruction_manual_2012_02.pdf

Date added: August 22, 2013 - Views: 30

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A Guide for Completing the CMS- 1500 Form

Blue Cross and Blue Shield of Illinois offers this guide to help you complete the CMS-1500 (02/12) form for your patients with BlueShield coverage.

http://www.bcbsil.com/pdf/education/tutorials_user_guides/cms_user_guide.pdf

Date added: March 8, 2012 - Views: 25

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New CMS - 1500 Medi-Cal Guide

New CMS-1500 Medi-Cal Guide • This . New CMS-1500 Medi-Cal Guide. will show you field by field what has changed on the new 02/12 version of the

http://files.medi-cal.ca.gov/pubsdoco/Claims/Downloads/NewCMSguide_21966.pdf

Date added: December 16, 2013 - Views: 3

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CMS 1500 Form - MDCodeWizard

PICA B. PLACE OF SERVICE 1a. INSURED’S I.D. NUMBER (For Program in Item 1) 4. INSURED’S NAME (Last Name, First Name, Middle Initial) 7. INSURED’S ADDRESS (No ...

http://www.mdcodewizard.com/CMS1500/CMS1500-0212-MDCW.pdf

Date added: May 1, 2014 - Views: 13

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F245-127-000 Provider Billing CMS 1500 HCFA 1500

12. PATIENT ’S OR AUTHORIZED PERSON S SIGNATURE I authorize the release of any medical or other information ... F245-127-000 Provider Billing CMS 1500 HCFA 1500

http://www.vcgcb.ca.gov/docs/forms/providers/cms1500.pdf

Date added: October 11, 2012 - Views: 55

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Chapter 5 Billing on the CMS 1500 Claim Form

The revised CMS-1500 version 02/12 will be required effective 4/1/2014. Claims submitted with the old CMS 1500 08/05 form will be returned, regardless of service date.

http://www.azahcccs.gov/commercial/Downloads/FFSProviderManual/FFS_Chap05_CMS1500.pdf

Date added: January 27, 2014 - Views: 18

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Revised CMS- 1500 Health Insurance Claim Form ( 02...

PROVIDER QUICK TIPS Revised CMS-1500 Health Insurance Claim Form (02/12) Effective July 1, 2014, professional claims submitted via paper billing must be submitted on ...

http://www.dpw.state.pa.us/cs/groups/webcontent/documents/communication/p_039776.pdf

Date added: January 27, 2014 - Views: 32

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Tips for Completing the CMS- 1500 Version 02/ 12...

Tips for Completing the CMS-1500 Version 02/12 Claim Form Page 2 of 14 Field Number Field Description Data Type Instructions 5 Patient's address, city,

http://www.valueoptions.com/providers/Forms/Administrative/Tips_for_Completing_the_CMS_1500.pdf

Date added: December 9, 2011 - Views: 66

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( 02/ 12) Claim Form Setup CMS-1500 (02/12) Claim...

The CMS1500 (02/12) Form was added in Helper 8.1. Clients who upgrade from a version prior to 8.1 have two options ...

http://www.helper.com/documents/helper/HelperCreate0212CMS1500Form.pdf

Date added: February 9, 2014 - Views: 26

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New CMS 1500 Form (version 02/ 12) - Care1st...

New CMS 1500 Form (version 02/12) Effective January 6, 2014 ... new CMS1500 Claim Form, consistent with the NUCC recommendation. On January 6, ...

https://www.care1st.com/az/PDF/provider/blastfaxes/2013/CMS1500Form_120513.pdf

Date added: January 27, 2014 - Views: 34

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APPROVED OMB-0938-1197 FORM 1500 ( 02- 12 ... -...

PLEASE PRINT OR TYPE APPROVED OMB-0938-1197 FORM 1500 (02-12) Title: SampleCMS1500_0212_040114_2 Created Date: 4/9/2014 11:52:27 AM

http://www.emblemhealth.com/~/media/Files/PDF/hcfa1500_emb.pdf

Date added: June 9, 2014 - Views: 1

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Guide to CMS - 1500 Form ( 02- 12) - Kareo - Go...

Guide to CMS-1500 Form (02-12) Instructions for CMS-1500 Claim Form (02-12) ... Note: This is indicated as a code on the CMS form; and typically

http://www.kareo.com/documents/Kareo_GuideToCMS1500Form0212.pdf

Date added: February 12, 2014 - Views: 5

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New CMS 1500 Implementation Reference Guide...

No Blue Shieldreports to CMA they will continue to allow practices to submit either CMS 1500 (version 08/05 or 02/12) onApril 1, 2014. Blue Shield will notify ...

http://www.cmanet.org/files/assets/news/2014/03/cms-1500-implementation-reference-guide-.pdf

Date added: April 16, 2014 - Views: 4

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REVISIONS TO THE CMS 1500 FORM AND PROGRAM ... -...

REVISIONS TO THE CMS 1500 FORM . AND . PROGRAM CHANGES FOR TRANSITIONING TO THE NEW FORM . CMS has issued a revision to the CMS 1500 08/05 form to the CMS 1500 02/12.

http://www.lamedicaid.com/provweb1/recent_policy/LIFT9122.pdf

Date added: March 17, 2014 - Views: 2

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Coming Soon! Revised CMS- 1500 Paper Claim Form...

revised version of the CMS-1500 paper claim form (version 02/12) which will replace thecurrent CMS - 1500 paper claim form (version 08/05). Revisions to the form include:

http://www.bcbsfl.com/wps/wcm/connect/c8c386e9-d5cb-450a-abdb-e111b234fc36/900-4136-1213+CMS+1500+Paper+Claim+Form+Bulletin+v2.pdf?MOD=AJPERES

Date added: January 14, 2014 - Views: 10

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A Guide for Completing the CMS- 1500 Form - BCBSTX

CMS-1500 (02/12) form for your patients with BlueShield coverage. Thank you for helping us to process your claims efficiently and accurately. B B B B B B B C R R R R ...

http://www.bcbstx.com/provider/pdf/cms_1500_npi_only.pdf

Date added: April 14, 2012 - Views: 51

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The Revised CMS- 1500 Form … at a Glance - Quill

The Revised CMS-1500 Form ... 02/12) to replace the current form (version 08/05). TFP Data Systems, the designated provider of the form, worked directly

http://images.quill.com/images/Products/catalog/Content/DataSheets/CMS1500_Datasheet.pdf

Date added: September 4, 2013 - Views: 10

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PROVIDER BULLETIN - Missouri Department of Social...

• January 6, 2014 – March 31, 2014: Providers can use either the current CMS -1500 form (08- 05) version or the revised CMS -1500 form (02- 12) version.

http://dss.mo.gov/mhd/providers/pdf/bulletin36-19_2014jan15.pdf

Date added: February 13, 2014 - Views: 4

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Form 1500 ( 02- 12) - Form Completion Instructions

Form 1500 (02-12) – Form Completion Instructions . Date of Notification April 1, 2014 Revision Date N/A ... COMPLETING THE REVISED CMS 1500 CLAIM FORM (02/12)

http://www.mercycareplan.com/assets/pdf/Form%201500%20(02-12)%20-%20Form%20Completion%20Instructions.pdf

Date added: April 20, 2014 - Views: 2

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Populating Item 15 on the New CMS-1500 (02-12)...

Genius Solutions, Inc. 3 dTHOMAS CMS-1500 Items 15 As payers update their specifications for the new CMS-1500 (02-12) form, we will be making additional

http://www.media.geniussolutions.com/94/Item15dT.pdf

Date added: June 7, 2014 - Views: 1

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CMS 1500 Update - Maryland

02-12 version of the CMS 1500 form, and all other claim forms. Maryland Medicaid will update its current CMS 1500 Billing Instructions in the coming months to ...

https://mmcp.dhmh.maryland.gov/SiteAssets/SitePages/ICD-10%20Conversion/February%202014.pdf

Date added: April 16, 2014 - Views: 2

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Completing a Paper CMS-1500 (02-12) Form

(continued) Harvard Pilgrim Health Care—Provider Manual F.42 December 2013 BILLING AND REIMBURSEMENT—RESOURCES Completing a Paper CMS-1500 (02-12) Form (cont.)

https://www.harvardpilgrim.org/pls/portal/url/item/3B00BB6D69A64556AE01ED47A74DAF3F

Date added: January 14, 2014 - Views: 12

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CMS-1500 (02/12) changes included in this update

CMS-1500 (02/12) changes included in this update The changes listed below will be used when the new CMS1500 (02/12) form option is selected for billing. ...

http://www.helper.com/documents/helper/Helper81Changes.pdf

Date added: April 20, 2014 - Views: 1

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THE NEW CMS 1500 (version 02/ 12) CLAIM FORM FIELD...

THE NEW CMS1500 (version 02/12) CLAIM FORM FIELD DIRECTIONS. The new paper claim form version was created in response to the changes and ...

http://dvha.vermont.gov/for-providers/cms1500-claim-form-directions-presentation.pdf

Date added: June 12, 2014 - Views: 2

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CMS- 1500 Claim Form Version 02/ 12 Submission of...

AD 14 101 CMS 1500 Form Update . UB04 Institutional - Corrected/Voided Claims Form Locator 4 on the UB04 Claim Form is used for the Bill Type. As outlined in the National

http://pa.performcare.org/pdf/providers/resources-information/policy-cms-1500-02-12.pdf

Date added: May 6, 2014 - Views: 2

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CMS-1500 02/12 Reference Guide for PROMISe™

CMS-1500 02/12 Reference Guide for PROMISe™ Effective July 1, 2014, professional claims submitted via paper billing must be submitted on the new 02/12 version of ...

http://www.dpw.state.pa.us/cs/groups/public/documents/communication/s_002286.pdf

Date added: February 16, 2014 - Views: 3

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Populating Item 14 on the New CMS-1500 (02-12)

Populating Item 14 on the New CMS-1500 (02-12) The new CMS-1500 form (02-12) ... Now, this item requires a qualifier to denote an illness/injury or pregnancy.

http://www.media.geniussolutions.com/94/Item14eT.pdf

Date added: July 2, 2014 - Views: 1

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Filling Out the CMS-1500 (02-12) - e-Referral

Enter up to 12 diagnosis codes, each on its own line. Use the highest level of specificity. Do not run the codes together on one line or use narrative

http://ereferrals.bcbsm.com/cms_instructions_02-12.pdf

Date added: September 20, 2014 - Views: 1

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Anthem BlueCross BlueShield Updated CMS 1500 Claim...

Updated CMS 1500 Claim Form. ... of an updated 1500 Claim Form (version 02/12) ... timeline for use of the 1500 Claim Form version 08/05 includes a dual submission

http://www.anthem.com/provider/noapplication/f1/s0/t0/pw_e212808.pdf?refer=ahpmedicare

Date added: June 12, 2014 - Views: 2

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NEW CMS- 1500 CLAIM FORM - Wyoming Medicaid -...

Effective July 1, 2014, Wyoming Medicaid will transition from the current professional claim form [CMS 1500 (08-05)] to the new professional claim form [CMS 1500 (02 ...

https://wyequalitycare.acs-inc.com/manuals/New%20CMS-1500%20Claim%20Form%20Bulletin.pdf

Date added: March 29, 2014 - Views: 4

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CMS-1500 02/12 - Montana

CMS-1500 (02/12) Please note the following: Using the 02/12 version with the 08/05 format does not work. The diagnosis codes for Box 21 end up

http://medicaidprovider.mt.gov/Portals/68/docs/forms/cms1500sample0212bwinstructions.pdf

Date added: March 26, 2015 - Views: 1

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Temporary Workaround for Printing Claims on the...

Temporary Workaround for Printing Claims on the New CMS-1500 (02-12) Claim Form – Only to customers running eClinicalWorks V9 Starting Tuesday April 1st, 2014 4/1 ...

http://www.nycreach.org/resources/Temporary%20Workaround%20for%20Printing%20Claims%20on%20the%20New%20CMS.pdf

Date added: April 28, 2014 - Views: 1

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The Revised CMS- 1500 Form … at a Glance

The National Uniform Claim Committee (NUCC) has announced the release of a revised 1500 Health Insurance Claim Form (version 02/12) to replace the current form ...

http://www.medclaimsoftware.com/CMS%201500%20changes.pdf

Date added: March 28, 2014 - Views: 3

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December 19, 2013 - Anthem

Updated CMS 1500 Claim Form version 02/12 to be accepted beginning January 6, 2014. In June 2013, the National Uniform Claim Committee (NUCC) ...

http://www.anthem.com/provider/noapplication/f1/s0/t0/pw_e211271.pdf?refer=ahpprovider

Date added: May 30, 2014 - Views: 1

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CMS- 1500 Claim Form/American National Standards...

CMS-1500 Claim Form/American National Standards ... Form version 02/12: ... Enter the qualifier to the left of the dotted vertical line on item 17.

http://www.cgsmedicare.com/pdf/5010_JobAid.pdf

Date added: November 8, 2012 - Views: 23

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New CMS 1500 Form Version 02/2012 - My Preferred...

New CMS 1500 Form Version 02/2012 Please note that starting April 1, 2014, this form will be a . ... (version 02/12) • NUCC submitted updated form to CMS for approval

http://www.mypreferredprovider.com/media/4701/NewCMS1500Form_Version%20022012_QuickLink.pdf

Date added: March 7, 2014 - Views: 1

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CMS-1500 (02/12) BILLING INSTRUCTIONS FOR APPLIED...

CMS-1500 (02/12) BILLING INSTRUCTIONS FOR APPLIED BEHAVIORAL ANALYSIS Locator # Description Instructions Alerts 1 Medicare / Medicaid / Tricare Champus /

http://www.lamedicaid.com/provweb1/billing_information/CMS_1500_%20Billing_Instructions.pdf

Date added: June 1, 2014 - Views: 7

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New CMS-1500 (02-12) and 2012 ADA Claim Forms May...

December 30, 2013 Announcement 678 New CMS-1500 (02-12) and 2012 ADA Claim Forms May Be Used Effective January 2, 2014; Three-Month Dual-Use Period Begins January 2

http://www.medicaid.nv.gov/Downloads/provider/web_announcement_678_20131230.pdf

Date added: February 9, 2014 - Views: 6

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New CMS-1500 (02-12) Claim Form - Wyoming Medicaid...

As of August 1, 2014, Medicaid will accept only the 02-12 version. Claims on any other version will be returned unprocessed.

http://wyequalitycare.acs-inc.com/manuals/CMS-1500+Bulletin+for+website.pdf

Date added: May 23, 2014 - Views: 2

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Updated CMS 1500 Form - Amerigroup

Updated CMS 1500 Form Why is this change necessary? On January 6, 2014, Amerigroup* started accepting the updated CMS 1500 Claim Form version

https://providers.amerigroup.com/Public%20Documents/ALL_CMS1500Update.pdf

Date added: April 16, 2014 - Views: 3

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2.0 CMS - 1500 Claim Form Instructions - Medicaid

Mississippi Medicaid Provider Billing Handbook CMS-1500 Claim Form Instructions Page 6 of 10 Field Requirement Field Name and for CMSInstructions -1500 (02/12) Form

http://www.medicaid.ms.gov/wp-content/uploads/2014/03/2.0-CMS-1500-Claim-Instructions.pdf

Date added: May 16, 2014 - Views: 2

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CMS Billing Instructions Revision Table

CMS-1500 Billing Instructions Provider Billing Manual CMS Billing Instructions . Revision Table . Revision Date ... changes made to the CMS 1500 (02-12) Claim Form.

http://www.dmap.state.de.us/downloads/manuals/CMS-1500.Billing.pdf

Date added: February 2, 2012 - Views: 14

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Instructions on how to fill out the CMS 1500 Form

Instructions on how to fill out the CMS 1500 Form telephone number. Item 6 Patient’s Relationship to Insured If Medicare is primary, leave blank.

http://www.lacare.org/files/English/file/Providers/DownloadableForms/ClaimsForms/HCFA%201500%20instructions.pdf

Date added: November 23, 2011 - Views: 63

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CMS 1500 Form Quick Reference Chart (Version 02/ ...

CMS 1500 Form (02/12) Page 3 information electronically. If there is no such contract, the beneficiary must file his/her own supplemental claim.

http://www.cahabagba.com/documents/2015/02/cms-1500-form-quick-reference.pdf

Date added: May 26, 2015 - Views: 1