NPI and Paper Claim Forms CMS-1500/UB-04

PROVIDER Quick Tip 24

NPI and Paper Claim Forms
CMS-1500 (Professional)
UB-04 (Institutional)

As a result of the Health Insurance Portability and Accountability Act of 1996 (HIPAA), the federal Department of Health and Human Services has mandated the use of the National Provider Identifier (NPI) number, which is the standard unique identifier for health care providers. Every health care provider, as defined by CMS, will be required to obtain and use an NPI number to enable provider identification on electronic transactions. HIPAA regulations adopt standards for format and content oFf certain electronic health transactions; they do not address the content of paper claims transactions. DHS will accept, but not require, the NPI on the revised paper forms, CMS 1500 (08/05) and UB-04 (replacing the UB-92). See tables below.

USING THE NEW CMS-1500 (Professional)

January 2, 2007 through March 30, 2007	Either the old CMS-1500 or the new CMS-1500 will be accepted. Medical Assistance Identification (MAID) Number must be used. NPI is optional but requested.
Effective April 2, 2007	Only the new CMS-1500 will be accepted. Medical Assistance Identification (MAID) Number must be used. NPI is optional but requested.

USING THE UB-04 (Institutional)

March 1, 2007 through May 22, 2007	Either the UB-92 or the UB-04 will be accepted. Medical Assistance Identification (MAID) Number must be used. NPI is optional but requested.
Effective May 23, 2007	Only the UB-04 will be accepted. Medical Assistance Identification (MAID) Number must be used. NPI is optional but requested.

Check the DHS web site often at www.dhs.pa.gov

NPI and Paper Claim Forms CMS-1500/UB-04 – Download [Optimized PDF]

NPI and Paper Claim Forms CMS-1500/UB-04 – Download