New CMS 1500 Form, CR 35494

April 14, 2014

As you know, Medicare began accepting the new CMS-1500 (2/12) claim form earlier this year and stopped accepting the old form as of 4/1/2014. MaineCare is currently accepting the new forms; however, we are only transferring the data that has previously been entered on the older form.

Please Note:

  • Box 14, DATE OF CURRENT ILLNESS, INJURY, or PREGNANCY (LMP) – If two qualifiers are present, code 431 will be used

  • Box 15, OTHER DATE – If multiple qualifiers are present, code 439 will be used

  • Box 21, DIAGNOSIS OR NATURE OF ILLNESS OR INJURY – When submitting more than 4 diagnosis, only the first 4 will be captured

At this time, any new fields present or completed on the CMS-1500 (2/12) claim form will be disregarded. MIHMS is being updated to accept data from the new version CMS-1500 (2/12) claim form. We will continue to process both versions until then and will notify you when the older CMS-1500 version will no longer be accepted.