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December 2013

BCBSM to begin accepting new CMS-1500 claim form Jan. 6, 2014

As you read in the November Record, Blue Cross Blue Shield of Michigan will begin accepting a revised CMS-1500 claim form (version 02/12) on Jan. 6, 2014. It will replace the current form (version 08/05) as well as the Michigan Status Claim Review Form.

You can continue to use the current CMS-1500 claim form through March 31, 2014. From Jan. 6, 2014, through March 31, 2014, health care providers can submit either version of the form. New claim forms (version 02/12) received prior to Jan. 6, 2014, will be returned.

Keep in mind that this form will be used for all lines of business and applies to BCBSM Medicare Advantage as well.

To help you prepare to use the new version of the form, we’ll include line-by-line instructions for completing it in the "Claims" chapter of our online provider manual by Jan. 6. (The "Claims" chapter will include two sets of instructions for completing CMS-1500 claims — one for each version — until April 1, 2014.)

You’ll be able to order the new form (version 02/12) after Jan. 1, 2014, by accessing the Blue Pages Directory chapter of your online provider manual on web-DENIS and completing the Facility and Professional Supply Requisition Form.

For more information, contact your provider consultant or visit NUCC.org*.

*BCBSM does not control this website or endorse its general content.

No portion of this publication may be copied without the express written permission of Blue Cross Blue Shield of Michigan, except that BCBSM participating health care providers may make copies for their personal use. In no event may any portion of this publication be copied or reprinted and used for commercial purposes by any party other than BCBSM.

*CPT codes, descriptions and two-digit numeric modifiers only are copyright 2012 American Medical Association. All rights reserved.
Blue Cross Blue Shield of Michigan and Blue Care Network are nonprofit corporations and
independent licensees of the Blue Cross and Blue Shield Association.