TO:    All Providers

Alabama Medicaid to Accept Revised Form Beginning January 6, 2014.

The CMS-1500 Claim Form has been revised to more adequately support the use of the ICD-10 diagnosis code set, which is important as the October 1, 2014 transition approaches. The revised CMS-1500 form (version 02/12) will replace CMS-1500 (version 08/05). The revised form will give providers the ability to indicate whether they are using ICD-9 or ICD-10 diagnosis codes and also allows for additional diagnosis codes, expanding from 4 possible codes to 12 possible codes. Please note:

·         ICD-9 codes must be used for services provided before October 1, 2014

·         ICD-10 codes must be used for services provided on or after October 1, 2014

Alabama Medicaid will begin accepting the revised form on January 6, 2014. 

• Claims submitted on the revised CMS-1500 (version 02/12) form prior to January 6, 2014 will be returned without being processed.

• Claims submitted on the retired CMS-1500 (version 08/05) form on or after April 1, 2014 will be returned without being processed.

HP Enterprise Services does not supply this form.  Providers should obtain this form from a vendor supplying current CMS-1500 forms.

REMINDER:  Alabama Medicaid requires all claims be submitted electronically.  The only time a provider should submit a paper claim is for administrative review or other exceptions previously outlined. If you have any questions, please contact the Provider Assistance Center at 1-800-688-7989.