11 NCAC 12 .1503             REQUIREMENTS FOR USE OF HCFA FORM 1500

(a)  Effective January 1, 1995, the HCFA Form 1500 shall be the standard claim form for all manual individual health care provider billing, and the HCFA Form 1500 shall be accepted by all payors conducting business in this State.

(b)  Effective January 1, 1995, with implementation to be complete no later than April 1, 1995, the following additional information and placement location shall be required for the HCFA Form 1500:

(1)           The provider tax I.D. number shall be located in form locator 25.

(2)           The ethnic origin code shall be located in form locator 1a as the subsequent set of numbers in that form locator; the first set of numbers being the insured's I.D. number.  Codes X1‑X5 (see definitions as defined in the State Uniform Billing Manual), to translate the ethnic origin codes, shall be used to designate the ethnic origin and preceded by the symbol "/".

(c)  Payors may require individual health care providers to use only the following coding system for the filing of claims for health care services:

(1)           ICD‑9‑CM Codes to report all diagnoses, reasons for encounters and procedures ‑ based upon code level changes made effective October 1 of each year or other effective date designated by the HCFA.

(2)           HCPCS Level 1 and 2 Codes ‑ based upon code level changes made effective October 1 of each year or other effective date designated by the HCFA.

(3)           CPT‑4 Codes based upon code level changes made effective January 1 of each year or other effective date designated by the HCFA.

(d)  When there is no applicable HCPCS Level 1 or Level 2 Code or modifier, the payor may establish its own code or modifier.  A complete list of all codes and modifiers established by payors must be published by and available upon request from payors by January 1, 1995.

(e)  Type of service codes may not be used after December 31, 1995.

(f)  Place of service codes and descriptions shall be recognized by all payors processing claims for services rendered in North Carolina on and after January 1, 1996.

(g)  Both HCFA physician and specialty codes and North Carolina Board of Medical Examiners specialty definitions shall be recognized by payors processing claims for services rendered in North Carolina on and after January 1, 1996.

(h)  A Uniform Billing Manual, similar to the concept used by the SUBC for HCFA Form 1450 (UB92), shall be developed to set forth HCFA Form 1500 standards by August 1, 1995.  The SUBC, along with the North Carolina Medical Society, may develop and recommend a Uniform Billing Manual to the Commissioner by August 1, 1995.  This manual may include standards established by the National Uniform Billing Committee as reflected in its ANSI 837 Guide to be released in February of 1995.

 

History Note:        Authority G.S. 58‑2‑40; 58‑3‑171;

Eff. October 1, 1994;

Amended Eff. February 1, 1995.