Effective April 1, 2014, the IHCP will accept only the
revised version of the CMS-1500
Effective April 1, 2014, the Indiana Health Coverage Programs
(IHCP) will accept only the revised version of the
CMS-1500 (02/12) paper claim form. Paper claims submitted
on the current version of the CMS-1500 (08/05) after March
31, 2014, will not be processed and will be returned to the
provider. The effective date for transition to the new form is
based on date of claim submission rather than date of service. For
more information and instructions about filling out the revised
CMS-1500, see IHCP Bulletin BT201353.
In addition, ICD indicators are required on all
UB-04 and revised CMS-1500 claim forms.
UB-04 and revised CMS-1500 claim forms with
missing or invalid ICD indicators will be returned to providers.
For more information, see IHCP Bulletins BT201352 and BT201353. If you
have questions, please contact Customer Assistance toll-free at