CMS 1500 08/05 Policy Regarding Submission of Paper Claim Forms

If the necessary information is not submitted or inaccurate, you will receive a Return to Provider Claims Report addressed to your provider location as indicated on the incomplete claim form. Blue Cross will return to the provider for correction all incomplete and/or inaccurate CMS-1500 paper claims that do not meet the following guidelines:

• Block 17b will require the referring provider’s National Provider Identifier (NPI).
• Block 24J will require the rendering provider’s NPI for each line item submitted.
• Blocks 32 and 33 may be an Organizational NPI or an Individual NPI.
• The NPI will need to be correlated with a valid tax identification (ID) number for the provider. That tax ID must be present in Block 25.
• The NPI will need to be valid and on file with Blue Cross Blue and Shield of Alabama.
• The provider can only submit one NPI per claim. Beginning May 23, 2007, a provider can only submit one NPI per claim.

If you receive a Return to Provider Claims Report, make the requested corrections and submit a new CMS-1500 claim form for additional processing consideration. In order to expedite processing, you should file these as new claims, not corrected bills. A CMS-1500 08/05 Claim Form example with the new highlighted fields is found on the following page.

Last Updated November 2008