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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: 81

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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 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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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 (02/12) CLAIM FORM INSTRUCTIONS

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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A Guide for Completing the CMS- 1500 Form - Blue...

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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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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CMS Manual System

CMS Manual System Department of Health & ... Revised for Form Version 02/12. EFFECTIVE DATE: CMS - 1500: January 6, 2014 . ICD-10 - Upon Implementation of ICD-10

http://www.cms.gov/Regulations-and-Guidance/Guidance/Transmittals/Downloads/R3083CP.pdf

Date added: August 29, 2015 - Views: 1

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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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Chapter 26 - Completing and Processing Form CMS- ...

Additional instructions for form version 02/12: Enter one of the following qualifiers as ... Form CMS-1500. When the Form CMS-1490S is used, an itemized bill must be

http://www.cms.gov/Regulations-and-Guidance/Guidance/Manuals/Downloads/clm104c26.pdf

Date added: June 22, 2012 - Views: 76

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Medicare Billing: 837P and Form CMS- 1500

R DEPARTMENT OF HEALTH AND HUMAN SERVICES Centers for Medicare & Medicaid Services FACT SHEET Medicare Billing: 837P and Form CMS-1500 Medicare FFS Contractors include

http://www.cms.gov/Outreach-and-Education/Medicare-Learning-Network-MLN/MLNProducts/downloads/form_cms-1500_fact_sheet.pdf

Date added: May 27, 2012 - Views: 344

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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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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: 14

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

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

New CMS 1500 Form (version 02/12) Effective January 6, 2014 December 5, 2013 ... new form prior to this date will be denied to resubmit on the current CMS Form

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

Date added: January 27, 2014 - Views: 34

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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: 13

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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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Anthem BlueCross BlueShield Updated CMS 1500 Claim...

Updated CMS 1500 Claim Form. ... of an updated 1500 Claim Form (version 02/12) ... list of changes between the 08/05 and 02/12 claim versions and the 1500 Instruction ...

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

Date added: August 29, 2015 - Views: 1

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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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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: 56

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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: 5

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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: 22

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Updated CMS 1500 Form - Home | Providers –...

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

Tips for Completing the CMS-1500 Version 02/12 Claim Form Page 3 of 14 Field Number Field Description Data Type Instructions 9d Other insured's

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

Date added: December 9, 2011 - Views: 67

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

The Revised CMS-1500 Form … at a Glance 9 23211-U Please be aware that the revised form is available for testing and preparation purposes only, and should not be ...

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

Date added: September 4, 2013 - Views: 14

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PLEASE PRINT OR TYPE APPROVED OMB-0938-1197 FORM ...

PLEASE PRINT OR TYPE APPROVED OMB-0938-1197 FORM 1500 (02-12) pt as . Created Date: 3/31/2014 3:17:39 PM

http://tricare-overseas.com/PDF/CMS1500_ver02-12.pdf

Date added: August 29, 2015 - Views: 1

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Medicare Billing: 837P and Form CMS- 1500 Fact...

Medicare Billing: 837P and Form CMS-1500. Please note: The information in ... CMS designates the 1500 Health Insurance Claim Form as the CMS-1500 (02/12) and

http://www.cms.gov/Outreach-and-Education/Medicare-Learning-Network-MLN/MLNProducts/Downloads/837P-CMS-1500.pdf

Date added: May 22, 2013 - Views: 6

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Grey indicates an N/A field that is Not Applicable...

PLEASE PRINT OR TYPE APPROVED OMB-0938-1197 FORM 1500 (02-12) Cyan indicates a Required field that must be completed. Otherwise, claim processing may be delayed

http://www.hmsa.com/PORTAL/PROVIDER/cms1500_interactive_02_12.pdf

Date added: April 12, 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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Claim Form Billing Instructions CMS- 1500 - New...

12 Not Required Patient’s or Authorized Person’s Signature: Not required ... Microsoft Word - Claim Form Billing Instructions CMS-1500 Author: 11042741

https://nmmedicaid.acs-inc.com/static/PDFs/Medicaid%20Publications/ClaimFormInstr/CMS-1500%20instructions.pdf

Date added: May 6, 2013 - Views: 2

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Form 1500 ( 02- 12) - Form Completion Instructions

Form 1500 (02-12) – Form Completion Instructions . ... The CMS-1500 health insurance claim form has been revised to the 1500 (02/12) version. In the new version,

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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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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NEW CMS-1500 CLAIM FORM

ACCEPT CMS 1500 (02-12) CLAIM FORM UNTIL JULY 2014. Effective July 1, 2014, Wyoming Medicaid will transition from the current professional claim form [CMS 1500 (08-

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

Date added: March 29, 2014 - Views: 4

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Until further notice, use qualifier “DN” Enter a...

Starting 3/3/2014, Vermont Medicaid will accept the CMS-1500 version 02/12 paper claim form. For the CMS-1500 version 02/12 paper claim form, the following billing ...

http://dvha.vermont.gov/for-providers/cms1500.pdf

Date added: March 15, 2014 - Views: 1

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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, ... 02/12 1500 Claim Form Map to the ASC X12 837P Frequently Asked Questions .

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 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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Filling Out the CMS-1500 (02-12)

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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MEDICAID BULLETIN - SC DHHS

MEDICAID BULLETIN All TO: Providers Indicated SUBJECT: Transition to the CMS-1500 Health Insurance Claim Form (02-12) version

https://www.scdhhs.gov/sites/default/files/CMS-1500%20%2802-12%29%20Bulletin%20Final%20Draft%2011142013.pdf

Date added: December 16, 2013 - Views: 1

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CMS 1500 Instructions - Welcome to Health...

Idaho MMIS CMS 1500 Instructions August 13, 2015 Page i Table of Contents 1. ... 7.0 All Published version 10/02/12 TQD 6.1 . Appendix C.5.2 Postpartum

https://www.idmedicaid.com/Claim%20Form%20Instructions/CMS%201500%20Instructions.pdf

Date added: May 6, 2012 - Views: 5

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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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CMS-1500 Required Field Information

CMS-1500 Required Field Information Field No. Field Name Explanation 1A Insured’s ID Number Enter the policyholder’s alpha-prefix and ID number as shown on

https://www.bcbsal.org/providers/pdfs/CMS1500BARequiredFields.pdf

Date added: January 11, 2013 - Views: 2

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Correction to “Updated CMS- 1500 Claim Form Will...

This is a correction to an article titled “Updated CMS-1500 Claim Form Will Be Accepted Beginning January 6, ... CMS-1500 version 02/12 paper claim form.

http://www.tmhp.com/News_Items/2013/12-Dec/12-13-13%20Correction%20to%20Updated%20CMS-1500%20Claim%20Form%20Will%20be%20Accepted%20Beginning%20January%206.pdf

Date added: January 14, 2014 - Views: 1

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New CMS-1500 (02-12) Claim Form

New CMS-1500 (02-12) Claim Form . WYOMING MEDICAID IS READY! At this time either version of the CMS-1500 Claim Form will be accepted.

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

Date added: May 23, 2014 - Views: 2

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CMS 1500 Claim Form Reference Guide(version 02- ...

Partial Implementation CMS-1500 (version 02/12) CLAIM FORM FIELD DIRECTIONS The new paper claim form version was created in response to the changes and requirements ...

https://www.vtmedicaid.com/Information/CMS1500%20Claim%20Form%20Reference%20Guide%20.pdf

Date added: August 29, 2015 - Views: 1

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CMS 1500 (02/12) INSTRUCTIONS FOR RHC/FQHC...

CMS 1500 (02/12) INSTRUCTIONS FOR RHC/FQHC SERVICES . Locator # Description Instructions Alerts . 1 Medicare / Medicaid / Tricare Champus / Champva / Group

http://www.lamedicaid.com/provweb1/billing_information/CMS_1500_RHC_FQHC.pdf

Date added: August 6, 2014 - Views: 1

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Empire BlueCross Updated CMS 1500 Claim Form

Updated CMS 1500 Claim Form. In June 2013, the National Uniform Claim Committee (NUCC) announced the approval of an updated 1500 Claim Form (version 02/12) ...

https://www.empireblue.com/shared/noapplication/f2/s2/t1/pw_e212811.pdf?refer=ehpprovider

Date added: August 29, 2015 - Views: 1