PROVIDER INFORMATION NOTICE
TO: Early Intervention Providers
FROM: Janet D. Gully, Chief
Bureau of Early Intervention
DATE: March 12, 2007
SUBJECT: NEW CMS 1500 AND UB 04 BILLING FORMS AND NATIONAL PROVIDER IDENTIFIER (NPI) INFORMATION
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CMS-1500 Billing Form
Beginning April 1, 2007 the (12/90) version of the CMS-1500 claim form will be discontinued. Providers nationwide will be required to use the revised (08/05) CMS-1500. The Early Intervention Central Billing Office will accept the (12/90) version of the form until May 23, 2007. Beginning May 23, 2007 all claims submitted on the CMS-1500 form must be submitted on the new (08/05) version. On or after May 23, 2007 all claims submitted on the old (12/90) version of this form will be denied. The revised (08/05) version of the CMS-1500 form has been available since October 1, 2006.
UB-04 Billing Form
The new UB-04 billing form was released for use on March 1, 2007. Beginning May 23, 2007 the old UB-92 form will be discontinued. Providers nationwide will be required to use the new UB-04 billing billing form. Beginning May 23, 2007 all claims submitted to the Early Intervention Central Billing on the UB billing form must be submitted on the UB-04 version. On or after May 23, 2007 all claims submitted on the old UB-92 version of this form will be denied.
National Provider Identifier (NPI)
Please keep in mind that for Early Intervention it is the individual provider (ex., PT, OT, DT) who is enrolled in the Early Intervention Central Billing Office (CBO) system. Not the payee. Therefore, it is the individual provider whose NPI number must be identified on all claims submitted to the CBO for payment on or after May 23, 2007. The exception is entities that provide Assistive Technology (AT) services. Some AT providers are enrolled as agencies.
In addition, Early Intervention providers are enrolled in the same manner with the Department of Healthcare and Family Services (HFS). When submitting your NPI numbers to HFS, it is the individual PT, OT, DT, etc., whose number must be submitted.
All providers have been asked to go to the HFS website at to enter their NPI information. Some of the information required includes the HFS provider type and category of service. For the provider type 55 and categories of service 007, 031 and 068 it has been determined that the provider should enter their provider type information under 199, unknown provider type and their category of service information under 199, unknown category of service. These categories are found at the bottom of the list. Providers who are enrolled with HFS under provider type 55 and categories of service 007, 031 and 068 include the following:
All other provider types should enter the required information based upon their discipline.
If you have questions about this notice please call the Early Intervention Central Billing Office Call Center at 800/634-8540. Thank you for your continued participation as a provider of Early Intervention services.
