02/12 Revisions to the HCFA Claim Form

Review the major changes to the new CMS 1500 HCFA 02/12; including eliminations, additions, and adjustments. Prepare your practice for a seamless transition and bill your claims with confidence.

A new mandated adjustment to the HCFA 1500 forms will reach health care providers beginning April 1 of this year. Use of these new 02/12 HCFA forms are optional to payers and providers from January 1 until April 1 2014, at which time the new form will become a hard and fast requirement and the old HCFA 08/05 will no longer be accepted by payers. This adjustment has been put into effect in order to align the industry with the upcoming reporting needs of the ICD-10 transition that is due to occur in October this year, and to align with the Accredited Standards Committee (ASC)  X12N 837P version 5010 ANSI standard format.

This adjustment brings with it a handful of changes to the previously accepted 08/05 version of the HCFA form. This means that providers and payers will have to get familiar with and adjust to these new revisions. Here we’ll take a brief review of these changes in an effort to highlight their breadth, nature, and how they will affect the chiropractic provider and their current practice processes.

The data previously reported in many of these HCFA fields are not reported in the electronic 837P, which is why some fields have been eliminated in the new 021/12 version of this form. Major changes to the HCFA form include:

  • Header: The 1500 symbol at the top of the form was replaced with a QR code that directs the user to the NUCC landing page for further information, and to provide a visual indicator with which to distinguish forms.
  • Box 1: Minor changes were made to the wording of payer ID number requirements. TRICARE CHAMPUS was changed to TRICARE, and SSN was replaced with ID#.
  • Box 8, 9b, and 9c: PATIENT STATUS, OTHER INSURED’S DATE OF BIRTH, SEX, and EMPLOYER’S NAME OR SCHOOL were deleted and titles were changed to RESERVED FOR NUCC USE.
  • Box 10d: This box was changed from RESERVED FOR LOCAL USE to CLAIM CODES in order to limit entries to reporting various claim codes, such as condition codes, although the NUCC will receive and review additional requests by e-mail at the info@nucc.org address.
  • Box 11b: This box title was changed to OTHER CLAIM ID and space was designated for reporting a qualifier to indicate the type of number being reported (Property or Casualty Claim Numbers). This also offers the flexibility to add additional future qualifiers and types of numbers, if necessary.
  • Box 14:  This box title was changed to DATE OF CURRENT ILLNESS, INJURY, or PREGNANCY (LMP) and a qualifier was added in order to identify which date is reported in this field.
  • Box 15: This box title was changed to OTHER DATE. Space to accommodate a qualifier was added in response to an industry request for the ability to report other dates associated with the claim. This format also allows for the flexibility to add additional future qualifiers.
  • Box 17: A qualifier field was added to this box to specifically identify which provider is being reported.
  • Box 19: This box title was changed to ADDITIONAL CLAIM INFORMATION in an effort to limit its use as an open text field. Specific needs related to this box can be submitted for review by e-mail at the info@nucc.org address.
  • Box 21: Eight additional lines were added to this box for further identification of diagnosis or nature of illness/injury. An indicator place was added in order to identify which codes are being reported on the claim; ICD-9 vs. ICD-10 codes. Line labels to letters were changed to letters in order to allow reporting of 2-digit pointers while still accommodating up to four pointers.
  • Box 22: Medicaid was eliminated from the title of this box so that the field can be used for resubmissions with any payer.
  • Box 30: BALANCE DUE was replaced with RSVD FOR NUCC USE.

To put our providers in position for this adjustment, necessary changes have been made to the ChiroTouch software to accommodate these new HCFA 02/12 claim form adjustments. We have also reached out to many of the major payers to inquire about grace periods to assure our clients that we have a comprehensive understanding of how this transition will affect their current operations. Contact ChiroTouch to learn more about how we can keep your practice running with a comprehensive approach to billing, compliance, and industry standards.

A crosswalk between the 1500 HCFA Claim Form version 02/12 and the 837P can be found on the NUCC website. We suggest reviewing materials under the 1500 Claim Form tab if you need additional information.

This information was brought to you by Integrated Practice Solutions, makers of ChiroTouch. Visit www.ChiroTouch.com.