SECTION 365:10-1-32. Requirements for use of HCFA Form 1500 and HCFA Form 1491

(a)   Health care practitioners shall use the HCFA Form 1500 and instructions provided by HCFA for use of the HCFA Form 1500 when filing claims with third party payors for professional services. HCFA Form 1491 may be used instead of the HCFA Form 1500 when filing claims for transportation and/or ambulance services.

(b)   The requirement set forth in 365:10-1-32(a) does not apply to:

(1)   dental services which are billed by dentists using the ADA-1990 Dental Claim Form and CDT-1 Codes, or

(2)   pharmacists or pharmacies which are filing claims for prescription drugs.

(c)   A third party payor may not require a health care practitioner to use any coding system for the filing of claims for health care services other than the following:

(1)   HCPCS Codes,

(2)   ICD-10 Codes, or

(3)   CPT Codes.

(d)   Except as provided in 365:10-1-36(c), a third party payor may not require a health care practitioner to use any other description with a code or to furnish additional information with the initial submission of a HCFA Form 1500 except under the following circumstances:

(1)   when the procedure code used describes a treatment or service which is not otherwise classified, or

(2)   when the procedure code is followed by modifiers in which case the practitioner may use the HCFA Form 1500 to explain the modifiers.

(e)   A health care practitioner may use the HCFA Form 1500 to indicate the form is an amended version of a form previously submitted to the third party payor by inserting the word "amended" in Box 19, currently titled "Reserved for Local Use".

(f)   A health care practitioner whose billing is based on the amount of time involved shall indicate the number of units in Box 24G, currently titled "Days or Units", of the HCFA Form 1500 if it is not used to specify the number of days of treatment.

[Source: Added at 11 Ok Reg 3295, eff 7-1-94; Amended at 29 Ok Reg 1254, eff 7-14-12]