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MedLook Weekly Tip For 04/09/2007

NPI - The Old and the New CMS 1500 Format   Return to Archive

The new NPI changes that have been implemented on the CMS 1500 form have made for an interesting time of transition. Many carriers require the new format on paper while many clearinghouses still require the old format. This makes sense in that a clearinghouse is able to keep a local database for each client with their NPI numbers and still ingest the old format. This allows clients to continue to use their old software without upgrading to the new format. However, paper claims absolutely require an update.

MedLook provides templates (see c:\Program Files\Rem Systems\MedLook\Template) for both the new and old format 1500 forms for paper and electronic claims. The Template folder contains the following files as defined here:

Cms1500Default.xml A default file for easy recovery (seldom used).
Cms1500Formats.xml The old (pre-NPI) formatted CMS 1500 layout file (Paper and Electronic).
Cms1500NPI.xml The new NPI formatted CMS 1500 layout file (Paper and Electronic).
Cms1500npiPaperOldElectronic.xml This file contains the new CMS 1500 layout for Paper and
the old layout for Electronic claims.


The CMS 1500 boxes directly affected by the update are:
Box 17a/b (a) UPIN and (b) NPI
Note: See the CMS Claims form manual regarding the old (U)PIN fields. You may have to enter the two digit qualifier identifying the non-NPI number followed by the ID number. The same holds for all old PINs in each box.
Box 24c The TOS field has been dropped and EMG is now in box c. TOS has been, and still is in many cases, cause for claims rejections and yet it has no place or value on the new form.
Box 24e This is only a pointer to box 21. Codes are no longer allowed.
Box 24i This MAY require the 2-digit ID qualifier mentioned above.
Box 24j The top is for the 24k data from the old form (carrier provided PINs).
The bottom is for the NPI number. In some cases reported so far this field should be left blank for a solo practice and only box 33a should be filled in.
Box 24 The top of a-h is used for supplemental information.
To enter this information for a charge the charge comment must begin with an "!".
Box 32a/b (a) NPI and (b) old Facility PIN
Box 33 The phone number is above all the other fields in a new position.
Box 33a/b (a) NPI and (b) old PIN