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Unprocessed CMS-1500 Claims? Check the Date

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  • July 30, 2018
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Unprocessed CMS-1500 Claims? Check the Date

Medicare claims that do not meet date format requirements will be rejected.

The Centers for Medicare & Medicaid Services (CMS) has released date formatting guidelines for the CMS-1500 claim form, which are effective for claims received on or after July 30. When date formatting requirements are not met, Medicare Administrative Contractors will return claims as “unprocessable” with the following messages:

  • Claim/Service lacks information or has submission/billing error(s).
  • Incorrect claim form/format for this service.
  • You may not appeal this decision.

Check Your Dates

CMS requires billers to report an eight-digit birth date in the following items on the CMS-1500:

  • 3 – Patient’s Birth Date
  • 9b – Other Insured’s Date of Birth
  • 11a – Insured’s Date of Birth

Important: For these items, only, make sure there is a space between the month, day, and year (i.e., MM_DD_CCYY).
You may continue to use a six- or eight-digit date for the following items:

  • 11b – Employer’s Name or School Name
  • 12 – Patient or Authorized Representaive
  • 14 – Date of Current Illness
  • 16 – Dates Patient Unable to Work in Current Occupation
  • 18 – Hospitalization Dates Related to Current Services
  • 19 – Additional Claim Information (Designate by NUCC)
  • 24a – Date of Service
  • 31 – Provider of Service or Supplier, or their Authorized Representative

However, items 11b, 14, 16, 18, 19, and 24a must be formatted consistently, and 24a must be one continuous number (i.e., MMDDCCYY), without spaces between the month, day, and year. In other words, you must format items 11b, 14, 16, 18, 19, and 24a using one continuous eight-digit number. To make it easier to remember, you might as well format all dates in these items using an eight-digit format.
In sum: Use an eight-digit format for dates, without spaces, except for items 3, 9b, and 11a, which require a space between the month, day, and year.
You have to admit, CMS keeps us on our toes!

Source: Novitas Solutions.

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Renee Dustman, BS, AAPC MACRA Proficient, is managing editor - content & editorial at AAPC. She holds a Bachelor of Science degree in Media Communications - Journalism. Renee has more than 30 years' experience in journalistic reporting, print production, graphic design, and content management. Follow her on Twitter @dustman_aapc.

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