August 25, 2022
The CMS-1500 Field Table Matrix for XML submission was updated on 8/25/22 to minimize validation edits for fields 16, 18 and 24D.
August 17, 2022
August 2, 2022
The CMS-1500 Field Table Matrix for XML submission was updated on 8/1/22 to minimize validation edits for fields 18, 19 and 33.
July 12, 2022
July 5, 2022
June 30, 2022
- Additional Payer FAQ
- Clarified use of specific CARC/RARC in Phase 3
May 27, 2022
May 12, 2022
April 25, 2022
- Additional information on Phase 3 of the timeline regarding implementation of new C-8.1B and C-8.4 forms.
April 14, 2022
March 30, 2022
- Subject Number 046-1362R3 – Important Updates Regarding Forms C-8.1 and C-8.4, Including Implementation Dates Related to the CMS-1500 Initiative
March 23, 2022
March 18, 2022
- CMS-1500 Field Table Matrix for XML Submission has been modified to correct validation edits causing production issues.
February 23, 2022
February 11, 2022
January 26, 2022
January 21, 2022
December 13, 2021
December 7, 2021
October 29, 2021
October 18, 2021
XML Submission Partner FAQ clarification on populating the Insurer ID (W Number).
September 29, 2021
Effective October 1, 2021, payers are required to have one or more Board-approved XML submission partners to transmit and accept health care provider medical bills via Electronic Data Exchange (EDI) or another format agreed upon with the XML submission partner. Payers must designate with the Board at least one XML submission partner from whom they will accept medical bills by October 30, 2021.
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).