SOURCE: Medical Business Systems

Medical Business Systems

April 23, 2014 14:20 ET

Iridium Suite Implements New HCFA 1500 Claim Form

RENO, NV--(Marketwired - Apr 23, 2014) - Medical Business Systems is proud to announce that its cloud-based practice management system, Iridium Suite, is compliant with the new HCFA 1500 form standards that took effect on April 1, 2014. The new HCFA 1500 paper claim form changes are required, in spite of the recently legislated delay in the implementation of ICD-10. Iridium Suite offers billers the flexibility to choose whether to use the new HCFA 1500 claim form or the prior version when sending out paper claims. Some payers may require use of the previous HCFA 1500 form when re-invoicing claims with dates of service prior to April 1, 2014.

The new format was introduced to align the claim with the 5010 837P standards and to accommodate ICD-10 reporting needs. There are numerous differences between the old HCFA 1500 claim form (FORM CMS-1500 08-05) and the new form (FORM CMS-1500 02-12). Some changes are minor while other changes are more significant.

The new HCFA 1500 allows the medical biller to enter 12 unique diagnosis codes per claim in Box 21. This represents a significant increase from the old version which allowed only four diagnosis codes. The diagnosis codes are labeled from A-L as opposed to 1-4 in the previous format. Iridium Suite accommodates the inclusion of 12 diagnosis codes per claim and allows the medical biller to "order" the diagnosis codes appropriately based on the patient's specifics. Box 21 also includes an indicator that is used to signal whether the codes listed are in ICD-9 or ICD-10 format.

Several changes were made to the HCFA 1500 to alter boxes that were previously used to report data that is no longer required per the 5010 837P standards:

  • Box 8 now reads, "Reserved for NUCC Use". This box previously contained data regarding the patient's marital status and employment status.
  • The "other insured's date of birth and sex" is no longer required, so Box 9b has been changed to "Reserved for NUCC Use". 
  • "Employer's Name or School Name" has been removed from boxes 9c and 11b and has been replaced with more generic language to provide flexibility in case individual payers implement new claim data requirements in the future.
  • "Balance Due" has been removed from Box 30 and the box now indicates "Rsvd for NUCC". Some individual payers may still require the Balance Due to be printed on paper claim forms, so it is important that your billing system is capable of understanding payer specific rules and applying them automatically and appropriately without requiring time-consuming biller intervention. Iridium Suite is easily configured to complete each HCFA 1500 as required on a payer-by-payer basis.

Minor HCFA-1500 form changes include:

  • At the top left corner of the form, the identifier "1500" has been replaced by a QR Code (Quick Response Code).
  • In Box 1, "Tricare" replaces "Champus".
  • In the prior version of the form, Box 10d read, "Reserved for Local Use" which has been changed to "Claim Codes (Designated by NUCC)".
  • Box 19 verbiage has been changed from "Reserved for Local Use" to "Additional Claim Information (Designated by NUCC)".
  • The verbiage in box 22 has been changed from "Medicaid Resubmission Code" to "Resubmission Code" to provide additional flexibility in the form.

About Medical Business Systems

Medical Business Systems is a leader in the healthcare software marketplace. Iridium Suite is the company's flagship product and has the distinct advantage of being created in a clinical setting rather than in a disconnected IT setting. Iridium Suite's ICD-10 readiness allows its users to be compliant with the new ICD-10 rules well in advance of the October 1, 2015 deadline.

For more information, please visit http://www.iridiumsuite.com

Contact Information

  • To learn more about Iridium Suite medical billing software, please contact:
    Susan Morrison
    Medical Business Systems
    Office: (775)453-3193
    Email Contact