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CMS 1500 Claim Processing Update: Qualifiers must accompany Dates entered in Fields 14 and 15

Effective April 1, 2019 Horizon BCBSNJ will change the way we process certain paper CMS 1500 claim form submissions to align our processing approach with how we process electronic transaction submissions.

Beginning April 1, 2019, paper CMS 1500 claim submissions that include a date within fields 14 and 15 must also include an appropriate Qualifier value (as noted in the table in below) to identify the date being reported.

CMS 1500 Field

Qualifier Values¹

14. Date of Current Illness, Injury or Pregnancy (LMP)

431 - Onset of Current Symptoms or Illness

484 - Last Menstrual Period

15. Other Date

(This field identifies additional date information about the patient’s condition or treatment.)

454 - Initial Treatment

304 - Latest Visit or Consultation

453 - Acute Manifestation of a Chronic Condition

439 - Accident

455 - Last X-ray

471 - Prescription

090 - Report Start (Assumed Care Date)

091 - Report End (Relinquished Care Date)

444 - First Visit or Consultation

CMS 1500 forms that include date values in fields 14 or 15 that do not also include an appropriate Qualifier value will be rejected. You will receive a letter advising when a CMS 1500 claim is rejected for this reason.

If your CMS 1500 claim is rejected for this reason, please submit a new claim with complete/correct information to the claims address noted on the back of your patient's Horizon BCBSNJ member ID card.

This change to our approach to processing CMS 1500 forms is in accordance with the National Uniform Claim Committee (NUCC) guidelines. Visit NUCC.org to review the most current version of instructions for the CMS 1500 claim form.

If you would like information about submitting electronic claim transactions to us, please contact our EDI team by calling 1-888-334-9242 or emailing HorizonEDI@HorizonBlue.com

¹A Qualifier value is not required if a date is not entered.

Published on: February 26, 2019, 14:08 p.m. ET
Last updated on: February 26, 2019, 14:09 p.m. ET