September 23, 2008
Tips to remember -- CMS-1500 (08/05) paper claim form
Effective for claims received on or after July 2, 2007: Providers who submit paper claims may only use the revised CMS-1500 (08/05). The CMS-1500 (12/90) version should not be submitted and, if received, will be returned to the provider.
Items 17, 17a & 17b -- Referring or ordering physician
Items are required when a service has been ordered or referred by a physician.
• Item 17 -- Enter the ordering or referring provider’s name.
• Item 17a -- DO NOT COMPLETE. Claims with information in Item 17a will be returned/rejected.
• Item 17b -- Enter the referring or ordering provider’s valid National Provider Identifier (NPI).
Item 24J -- Rendering provider number
Complete this item if billing services rendered by an individual associated with an incorporated entity or a group. A rendering provider NPI should not be submitted if the billing provider is an independent lab, Ambulatory Surgical Center (ASC), Independent Diagnostic Testing Facility (IDTF), ambulance supplier, or solo practitioner not associated with a group.
• Upper, shaded portion of Item 24J -- DO NOT COMPLETE. Claims with information in the upper portion of Item 24J will be returned/rejected.
• Lower, non-shaded portion of Item 24J -- Enter the rendering provider’s valid NPI.
Item 32a & 32b -- Service facility number
Items are to be completed if you are reporting purchased diagnostic services on your claim. For all purchased diagnostic services, you should also complete Item 20.
• Item 32a -- Enter the valid NPI of the service provider from whom the services were purchased.
• Note: Do not report the NPI of a service provider outside of Florida. For services purchased from outside Florida, enter the NPI of the provider who purchased the service.
• Item 32b -- DO NOT COMPLETE. Claims with information in Item 32b will be returned/rejected.
Item 33a & 33b -- Billing provider number
• Item 33a -- Enter the billing provider’s NPI
• Item 33b -- DO NOT COMPLETE. Claims with information in Item 33b will be returned/rejected.
Reminder
Claims will be rejected or returned as unprocessable if a legacy provider number is submitted in any item, if required information is not included, the information submitted is invalid, or if a valid NPI is submitted in the wrong item.
For more information
See the CMS Medicare Claims Processing Manual Pub. 100-04, Chapter 26, Section 10 
. View CMS-1500 claim form revisions on the National Uniform Claim Committee’s (NUCC) Web site .
. View CMS-1500 claim form revisions on the National Uniform Claim Committee’s (NUCC) Web site .Source: CMS Internet Only Manual (IOM) Publication 100-04 Medicare Claims Processing Manual, Chapter 1, Sections 10.1.1-10.1.1.2 & 30.2.9, Chapter 13, Section 20.2.4 & Chapter 26, Section 10.4,
CR 5858 - Medicare Fee for Service Legacy Provider IDs Prohibited on Form CMS-1500 Claims after NPI Required Date,
CR 5543 - Implementation of Carrier Jurisdictional Pricing Rules for All Purchased Diagnostic Service Claims.
CR 5858 - Medicare Fee for Service Legacy Provider IDs Prohibited on Form CMS-1500 Claims after NPI Required Date,
CR 5543 - Implementation of Carrier Jurisdictional Pricing Rules for All Purchased Diagnostic Service Claims.
