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Paper Claim Submitter Alert

Please be advised that, as of November 1, 2007, BCBSTX will no longer be accepting claims submitted on the CMS-1500 (version 12/90) or UB-92 claim form. CMS-1500 (12/90) or UB-92 claim forms that are received after October 31, 2007, will be returned to you with a reminder letter to resubmit your claims using the correct version of the form.

As a reminder, professional providers filing with BCBSTX should now be using the current version of the CMS-1500 (version 08/05). Facility providers should now be using the new UB-04 claim form.

For additional information on the revised CMS-1500 claim form, visit the National Uniform Claim Committee (NUCC) Web site at www.nucc.org. For additional information on the new UB-04 billing form, visit the National Uniform Billing Committee (NUBC) Web site at www.nubc.org.

Note: The mandatory use date for CMS-1500 (08/05) and UB-04 CMS-1450 claim forms for submission of clean health care claims is July 18, 2007.

Pursuant to the Texas Department of Insurance Commissioner’s Bulletin #B-0030-07 dated July 17th, Section 21.2803(b)(1) mandates the use of form CMS-1500 (08/05) for physicians and non-institutional providers for non-electronic claims filed or re-filed on or after the later of July 18, 2007, or the earliest compliance date required by CMS for mandatory use of the CMS-1500 (08/05) form for Medicare claims.  Section 21.2803(b)(2) mandates the use of form CMS-1500 (12/90) for physicians and non-institutional providers for non-electronic claims filed or re-filed before the later of July 18, 2007, or the earliest compliance date required by CMS for mandatory use of the CMS-1500 (08/05) form for Medicare claims.