[Federal Register: December 2, 2005 (Volume 70, Number 231)]
[Notices]
[Page 72305]
From the Federal Register Online via GPO Access [wais.access.gpo.gov]
[DOCID:fr02de05-42]
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DEPARTMENT OF HEALTH AND HUMAN SERVICES
Centers for Medicare & Medicaid Services
[Document Identifier: CMS-1500 (12-90), CMS-1490-U, CMS-1490-S, CMS-
1500 (08-05)]
Agency Information Collection Activities: Proposed Collection;
Comment Request
AGENCY: Centers for Medicare & Medicaid Services.
In compliance with the requirement of section 3506(c)(2)(A) of the
Paperwork Reduction Act of 1995, the Centers for Medicare & Medicaid
Services (CMS) is publishing the following summary of proposed
collections for public comment. Interested persons are invited to send
comments regarding this burden estimate or any other aspect of this
collection of information, including any of the following subjects: (1)
The necessity and utility of the proposed information collection for
the proper performance of the agency's functions; (2) the accuracy of
the estimated burden; (3) ways to enhance the quality, utility, and
clarity of the information to be collected; and (4) the use of
automated collection techniques or other forms of information
technology to minimize the information collection burden.
1. Type of Information Collection Request: Extension of a currently
approved collection; Title of Information Collection: Health Insurance
Common Claims Form and Supporting Regulations at 42 CFR Part 424,
Subpart C; Form Number: CMS-1500 (12-90), CMS-1490-U, CMS-1490-S
(OMB: 0938-0008); Use: The Form CMS-1500 answers the needs of
many health insurers. It is the basic form prescribed by CMS for the
Medicare program and is only accepted from physicians and suppliers
that are excluded from the mandatory electronic claims submission
requirements set forth in the Administrative Simplification Compliance
Act (ASCA) Pub. L. 107-105 and the implementing regulation at 42 CFR
424.32. The Medicaid State Agencies, CHAMPUS/TriCare, Office of
Workers' Compensation Programs (OWCP), U.S. Railroad Retirement Board
(RRB), Blue Cross/Blue Shield Plans, the Federal Employees Health
Benefit Plan, and several private health plans also use it; it is the
de facto standard ``professional'' claim form. CMS is seeking re-
approval of the CMS-1500 (12/90), CMS-1490-U, and the CMS-1490-S
forms.; Frequency: Reporting--On occasion; Affected Public: State,
Local, or Tribal Government, Business or other-for-profit, Not-for-
profit institutions; Number of Respondents: 902,378; Total Annual
Responses: 957,204,707; Total Annual Hours: 46,383,364.
2. Type of Information Collection Request: New collection; Title of
Information Collection: Health Insurance Common Claims Form and
Supporting Regulations at 42 CFR Part 424, Subpart C; Form Number: CMS-
1500 (08-05), CMS-1490-S (OMB: 0938-NEW); Use: CMS is
simultaneously seeking approval for form CMS-1500 (08-05) and the CMS-
1500 (12-90). A concurrent approval for the two forms is needed to
allow the industry to prepare for the conversion, i.e. computer system
conversions and mass printing of the form CMS-1500 (08-05). The CMS-
1500 (08-05) will be accepted beginning in October, 2006. Its use will
be mandatory in 2007. In 2007, the CMS-1500 (12-90) and the
corresponding OMB control number will be discontinued. The Form CMS-
1500 answers the needs of many health insurers. It is the basic form
prescribed by CMS for the Medicare program and is only accepted from
physicians and suppliers that are excluded from the mandatory
electronic claims submission requirements set forth in the
Administrative Simplification Compliance Act (ASCA) Pub. L. 107-105 and
the implementing regulation at 42 CFR 424.32. The Medicaid State
Agencies, CHAMPUS/TriCare, Office of Workers' Compensation Programs
(OWCP), U.S. Railroad Retirement Board (RRB), Blue Cross/Blue Shield
Plans, the Federal Employees Health Benefit Plan, and several private
health plans also use it; it is the de facto standard ``professional''
claim form.; Frequency: Reporting--On occasion; Affected Public: State,
Local, or Tribal Government, Business or other-for-profit, Not-for-
profit institutions; Number of Respondents: 902,378; Total Annual
Responses: 957,204,707; Total Annual Hours: 46,383,364.
To obtain copies of the supporting statement and any related forms
for the proposed paperwork collections referenced above, access CMS'
Web site address at http://www.cms.hhs.gov/regulations/pra/, or E-mail
your request, including your address, phone number, OMB number, and CMS
document identifier, to Paperwork@cms.hhs.gov, or call the Reports
Clearance Office on (410) 786-1326.
To be assured consideration, comments and recommendations for the
proposed information collections must be received at the address below,
no later than 5 p.m. on January 31, 2006.
CMS, Office of Strategic Operations and Regulatory Affairs,
Division of Regulations Development--B, Attention: William N. Parham,
III, Room C4-26-05, 7500 Security Boulevard, Baltimore, Maryland 21244-
1850.
Dated: November 23, 2005.
Michelle Shortt,
Director, Regulations Development Group, Office of Strategic Operations
and Regulatory Affairs.
[FR Doc. 05-23596 Filed 12-1-05; 8:45 am]
BILLING CODE 4120-01-P