Old version of CMS-1500 claim form discontinued

As you’ve read in previous issues of The Record, Blue Cross Blue Shield of Michigan is no longer accepting the 08/05 version of the CMS-1500 claim form or the Status Claim Review Form, effective April 1, 2014.

You need to use the revised CMS-1500 form, version 02/12. This form replaces both the old CMS-1500 (version 08/05) and the Status Claim Review Form.

If you submit an old CMS-1500 form (version 08/05) or Status Claim Review Form, it will be returned.

You can order the revised CMS-1500 claim form (version 02/12) by completing the Facility and Professional Supply Requisition form. There are two ways to access the form.

1) Through your provider manual:

• From web-DENIS, click on BCBSM Provider Publications and Resources.
• Click on Provider Manual.
• Click on Provider Type and select yours from the “Make Selection” box.
• Click on the Search button and then on the Blue Pages Directory chapter.
• Click on Forms and supplies and then on Facility and Professional Supply Requisition.
• Print and complete the form and mail it, along with a check for the total amount of your order, to the address provided on the form.

2) Through the Newsletters & Resources page:

• From web-DENIS, click on BCBSM Provider Publications and Resources.
• Click on Newsletters & Resources.
• Click on Facility and Professional Supply Requisition form, which you can access from the list of frequently used forms on the right side of the screen.
• Print and complete the form and mail it, along with a check for the total amount of your order, to the address provided on the form.

For more information about the revised form, refer to your BCBSM provider manual, contact your provider consultant or check out the article in the March Record.