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New CMS-1500 Claim Date Guidelines

Along with countless other recent updates, the Centers for Medicare and Medicaid services (CMS) have also adjusted the date reporting guidelines for their CMS-1500 claims. This update affects all claims of this type that are submitted on or after July 30th, 2018, so be sure to review these rules to make sure that you are compliant.

According to CMS, billers must report a full eight-digit date with spaces in between the day, month, and year (MM_DD_YYYY)  for the following areas:

3.) Patient’s Birth Date

9b.) Other Insured’s Date of Birth

11a.) Insured’s Date of Birth

For other sections, billers have the option of reporting either the full eight-digit date or a shortened six-digit date (MM_DD_YY). These areas include:

11b.) Employer’s Name Or School Name

12.) Patient Or Authorized Representative

14.) Date Of Current Illness

16.) Dates Patient Unable To Work In Current Occupation

18.) Hospitalization Dates Related To Current Services

19.) Additional Claim Information (Designated By NUCC)

24a.) Date Of Service

31.) Provider Of Service Or Supplier, Or Their Authorized Representative

However, these CMS-1500 sections still have distinct rules. Item 24a must be written as a single number with no spaces (MMDDYY). In addition, this item–along with items 11b, 14, 16, 18, and 19–must all be stylized consistently. In other words, it is not acceptable to report item 14 as a six-digit date while also reporting item 18 as an eight-digit date. As a result, many experts recommend automatically using the eight-digit date format for all areas in order to make matters easier.

Any CMS-1500 claims that do not follow these guidelines will be denied with the message “Claim/Service lacks information or has submission/billing error(s). Incorrect claim form/format for this service.” Since this decision cannot be appealed, it is imperative to memorize these standards and implement them in your workplace as soon as possible.