Revisions to Form CMS-1500 Submission Requirements

CR5489 makes the following updates to the CMS-1500 requirements:

  • The requirement to submit the providerÕs Social Security Number in Box 25 has been removed
  • The requirement to report the PIN of the Skilled Nursing Facility in Box 23 has been removed
  • Clarification language was added to Box 17a, indicating the qualifier 1G precedes the Unique Physician Identification Number (UPIN)

In addition, language has been added regarding the completion of Item 25 (the provider of service or supplier federal tax identification number). Medicare providers are not required to complete this item for crossover claim purposes, since the Medicare contractor will retrieve the tax identification information from their internal provider file for inclusion on the Coordination of Benefits (COB) outbound claim. However, tax identification information is used in the determination of accurate National Provider Identification (NPI) reimbursement. Thus, reimbursement of claims submitted without tax identification information may be delayed.

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