Wiki HCFA 1500 20-12 FORM and Medicare

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ejlehman

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Has anyone else received denials regarding the new HCFA form? We started using the new form in March and are getting denials from Medicare stating that the provider information is missing or incomplete, but it is in the proper boxes. We are not having this issue with any other payers as of yet. Just looking to see if anyone else is having this issue. I have tried to get through on the IVR, but keep getting put on hold and told it is a 45 minute wait.
 
if you go to NUCC.org you will find the June 2013 manual for the 2/12 form, this will give you all the information field by field along with the qualifiers and their definitions. It sounds like you are missing a qualifier which is new for the 2/12 form. This manual also tells you when a field is mandatory and when it is optional.
 
effective date?

Is the 4/1/14 effective date based on the dos? I have March dos claims that are being rejected.
 
If you bill for any date of service, you must use the new form if you are submitting the claim after April 1. The issue that we seem to be having is the group NPI vs the rendering physician NPI and what they are recognizing on the new form in their system.
 
We have had every claim from Medicare Advantage BCBS deny, stating "ZIP code missing from Box 9." However, box 9 is not for ZIP codes... Provider services just says they don't know why, and we should resubmit. We did a few times with the same denial reason. When we called provider services, they didn't know what to do. Any thoughts?:confused:
 
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