How Will Mandatory Changes Affect Your Practice?

Does your current practice management software offer free real-time updates? Many providers are being forced to upgrade their current practice management software, at a premium, to accommodate the new changes. Other providers are not even being informed about the monumental changes by their practice management companies.

If you are interested in learning more about the upcoming HCFA changes or if you’re interested in learning about a very affordable way to always stay current with medical forms, new AMA medical codes and current medicare coding rules... Please contact us today for a live demo!

Why Our Practice Management System Can Help

La Jolla Digital is committed to making its practice management software a step above the rest. To that end, we research and implement numerous, but necessary changes that need to be made to our software in order to provide you a hassle-free, compliant practice management solution.

And, since our practice management software is web-based, you never have to worry about replacing old hardware with new, expensive hardware; experience down-time for important, and sometimes expensive updates; or deal with the headaches involved in keeping your practice management software compliant — we take care of all of that for you, free of charge.

See the benefits of using La Jolla Digital's Practice Management Solution

What Are the Mandatory Changes?

2006 brings two important changes to the way health claims are submitted and processed. A new provider identifier number will replace all other health plan provider identifiers, and a new claim form that includes a place to report the new provider identifier will replace the current HCFA 1500 form.

The Centers for Medicare and Medicaid Services (CMS) have created a new single provider identifier. This “National Provider Identifier (NPI)” will be used in all standard electronic transactions. The purpose is to encourage electronic transmissions by simplifying the claims process. It will allow physicians to submit claims to all health plans in the U.S. using one NPI. Beginning May 23, 2007, all HIPPA-covered entities, such as health care providers, health plans and health care clearinghouses will be required to submit their claims using the NPI.

In order to submit claims with the new NPI, the National Uniform Claims Committee (NUCC) has created a new 1500 Health Insurance Claim form. The new 1500 Claim Form includes a place to report the provider's NPI along with 40 other minor changes.

Beginning Feb. 1, 2007, the new 1500 Health Insurance Claim Form will replace the current HCFA 1500 form, also known as the CMS 1500 form. The new form was released on Dec. 1, 2005, for testing and transition preparation purposes.

NUCC Recommended Transition Timeline for the Revised 1500 Claim Form

The NUCC has recommended that the health care industry adopt the following timeline for the transition to the new version of the 1500 Health Insurance Claim Form (version 08/05).
  • October 1, 2006: Health plans, clearinghouses, and other information support vendors should be ready to handle and accept the revised (08/05) 1500 Claim Form.
  • October 1, 2006 – February 1, 2007: Providers can use either the current (12/90) version or the revised (08/05) version of the 1500 Claim Form.
  • February 1, 2007: The current (12/90) version of the 1500 Claim Form is discontinued; only the revised (08/05) form is to be used. All rebilling of claims should use the revised (08/05) form from this date forward, even though earlier submissions may have been on the current (12/90) 1500 Claim Form.

The NUCC strongly recommends that providers contact their health plans or clearinghouses/ vendors prior to submitting a claim on the revised form to ensure that they are prepared to accept the new form.

The NUCC is recommending this timeline, in part, to complement the transition from the UB-92 to the UB-04 that will begin in March 2007. In addition, the early transition will allow the industry to implement the revised 1500 Claim Form and ensure its function prior to the May 23, 2007 deadline for reporting the NPI.

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