July 2, 2021
June 14, 2021
- Additional Payer FAQs
- Updated Timeline. Payers will be mandated to accept electronic medical bills from clearinghouses and transmit Explanation of Benefits / Explanation of Review electronically on October 1, 2021. Beginning, July 1, 2022, it will become mandatory for Providers to submit the Form CMS-1500 and for Payers to use specific Claims Adjustment Reason Codes (CARC).
April 12, 2021
- Additional Provider, Payer and XML Submission Partner FAQs.
- Treating Health Care Provider's Agreement for XML Submission of CMS-1500 Forms and Medical Narrative Reports no longer needs to be notarized.
- The CMS-1500 Guide for New XML Submission Partners has been revised to reflect updated provider agreements (which no longer require notarization).
March 26, 2021
- Updated Additional Payer FAQs
March 10, 2021
- Updated Timeline. Payers will be mandated to accept electronic medical bills from clearinghouses on October 1, 2021. Mandatory submission of CMS-1500 by providers as well as electronic submission of Explanation of Benefits / Explanation of Review has moved to July 1, 2022.
January 13, 2021
- The listing of clearing houses who are testing or approved to become an XML Submission Partner for the CMS-1500 has been updated to include the web address for most submission partners.
- The Claim Adjust Reason Codes (CARCs) and Remittance Advice Remark Codes crosswalk has modified the RARC codes under objection reason #6, added a new objection reason #13 for failure to submit medical bills electronically, and renumbered subsequent objection reasons.
December 14, 2020
- Additional Provider and Payer FAQs
September 10, 2020
- FAQ Clarification
- FAQ Clarification on payer acceptance of the CMS-1500.
August 13, 2020
- Additional FAQ
- FAQ clarifies how payers should address the reduction of a bill to align with the Relative Value Unit (RVU) limitations in the Medical Fee Schedule.
July 27, 2020
- FAQ clarifies the correct approach for billing surgical procedures performed by a surgeon and an assistant
- CMS-1500 Examples
June 4, 2020
- Updated Timeline
- Several XML Submission Partners have been approved for CMS-1500 submissions. View XML Submission Partner Status
- FAQs Clarification
- Several FAQs have been updated to reflect the changes in the project timeline
April 23, 2020
March 26, 2020
- Edits to the XML schema for fields 0, 4, 32 and 33
January 30, 2020
- Examples of paper CMS-1500 submissions were updated to provide dates of service on or after January 1, 2020 (post implementation of the expanded provider legislation).