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09/12/2018

Medicare Update: CMS 1500 Forms and Novitasphere - B

by Matt Minnella, ANJC Director of Insurance and Regulatory Affairs

Medicare CMS 1500 Forms

We have heard from numerous members who have received rejections from Medicare due to a format issue concerning dates on the CMS 1500 claim submission form.  Our regional Medicare Administrative Contractor (MAC), Novitas, began rejecting claims that did not have the proper date formatting as of July 30, 2018.  The proper data formatting requirements are:

You must report an 8-digit birth date (MMDDCCYY) in the following places within the CMS 1500 form:

  • 3 - Patient's Birth Date
  • 9b - Other Insured's Date of Birth
  • 11a - Insured's Date of Birth

When reporting 8-digit birth dates, there must be a space between the month, day, and year (i.e., MM_DD_CCYY). On the CMS-1500 claim form, the space between month, day, and year is delineated by a dotted, vertical line.

You have the option of entering a 6-digit or 8-digit date in the following items:

  • 11b - Employer's Name or School Name
  • 12 - Patient or Authorized Representative
  • 14 - Date of Current Illness
  • 16 - Dates Patient Unable To Work in Current Occupation
  • 18 - Hospitalization Dates Related To Current Services
  • 19 - Additional Claim Information (Designated by NUCC)
  • 24A - Date of Service
  • 31 - Provider of Service or Supplier, or their Authorized Representative

Whether you use a 6-digit date or 8-digit date for items 11b, 14,16,18,19 and 24a, the format must be used consistently in each of these areas.

Note: When reporting a date in Item 24A, it must be one continuous number (i.e., MMDDCCYY), without spaces between month, day, and year.

For more detail directly from the Novitas website click here.


Reopenings and Redeterminations: Save time with Novitasphere – B

Novitas, the Medicare Administrative Contractor (MAC) for Jurisdictions H and Jurisdiction L, highly encourages providers to perform claim corrections and submit redeterminations on their claims through Novitasphere, its free internet portal.

One of the most utilized features within Novitasphere is the Claim Correction feature.  Part B customers can use this to submit their clerical error reopenings to Novitas. It’s simple: log in to Novitasphere, correct the claim, and submit. See how easy it is with our short educational video:

Providers interested in learning more about the claim correction process are encouraged to join one of the monthly Novitasphere Claim Correction Webinars.  Please visit the Educational Events page of our website for dates and to register for an upcoming event. 

One of our newest enhancements to Novitasphere is the Appeal Requests feature.  The Appeal Requests feature is used to submit a Redetermination request for finalized claims. Once logged in to Novitasphere, users can quickly search for and locate the claim, complete the Appeal Request, upload documentation, and submit.

Additionally, users are now able to view Appeal Development Letters and respond to requests for documentation needed to process pending Redeterminations.  Users will be able to obtain the outcome of appeal decisions by accessing copies of their Medicare Redetermination Notices

Finally, as a reminder, the MBI Lookup tool is now available in Novitasphere. This is your go-to resource to obtain the patient’s MBI number when they are unable to provide their new card. 

To find enrollment instructions, or view a copy of the User Manual, visit the Novitasphere Portal Center today!. For questions, please contact the Novitasphere Help Desk at 1-855-880-8424.

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