Optometry Coding & Billing Alert
Watch for Payer Differences With Claim Forms
Question: I need some help concerning the rules for billing on the new CMS-1500 form. We have been told that any date of service before April 1 could still be billed on the old form, but I just got a letter from Tricare stating that all dates of service billed after April 1 must be on the new form, even claims that are being rebilled from March. Can you advise?
Washington, D.C. Subscriber
Answer: CMS will only accept the new form effective April 1, even if you’re billing older dates of service. Although private payers may not be as strict, Tricare is one insurer that requires you to use the new version (02/12) effective April 1.
“April 1, 2014: Payers receive and process only Version 02/12 of CMS-1500 paper claims,” Tricare said on its website. “We expect commercial payers to adopt this same timeline.”
Resource: You can read Tricare’s bulletin on this at www.tricare.mil/tma/hipaa/documents/Nov-Dec 2013 Newsflash_CMS1500_25Nov2013_FINAL.pdf.
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