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What You Need to Know About the Revised 1500 Claim Form


The National Uniform Claim Committee (NUCC) has announced the release of a Revised 1500 Health Insurance Claim Form (version 02/12) to replace the current form (version 08/05).  In the latest development, the revised form has been approved by the Centers for Medicare & Medicaid Services (CMS), and is going thru it's final comment period with the Office of Management and Budget (OMB).  The NUCC anticipates some updates to the language on the back of the form, but no major changes to the front of the form.  Once it’s officially approved, a final version of the form will be released by the NUCC.  The completion date for this is currently unknown, but could be as early as December 2012.  New Medical Forms is a designated provider of the form, so you can be confident you’ll be informed of all the latest activity with the revised form.  


Q: Why was the 1500 Claim Form changed?
A: The form was revised to align the paper form with some of the changes in the electronic healthcare claims: Professional (837), 005010X222 Technical Report Type 3 (5010) and 005010X222A1 Technical Report Type 3 (5010A1).
Q: What is the latest revision?
A: The most recent is “Revision 02/12.”
Q: What are the specific changes that were made to the form?
A: The most significant changes were the addition of eight diagnosis codes in Item Number 21 and the addition of the QR Code at the top left of the form.  
Q: Why was the QR Code added to the top of the form?
A: The QR Code includes a link to an NUCC landing page that provides information about the form. It also helps align the form for the reader.
Q: How can I obtain the revised form?
A: The proposed changes have not yet been approved by the Office of Management and Budget (OMB) but are expected by December 2012.  To order form samples, contact New Medical Forms at:  admin@newmedicalforms.com.
Q: Where are completed forms sent?
A: Completed claim forms are to be sent to the insurance company, payer, or other entity responsible for paying the claim.  
Q: Can information be pre-printed on claim forms so it doesn’t have to be re-entered each time?
A: The information preprinted on forms should be left to each individual provider and should be information that will remain the same regardless of the payer the forms are being submitted to.  One example may be the Billing Provider Information.  Providers should check with their payers to make sure they accept claim forms with preprinted information.
Q: What font size should I use when completing the revised form?
A: The recommended font size is 10.
Q: Can only forms printed in red ink be used or can providers use a form that is copied or printed in black?
A: For the form to be read by a scanner, the form must be in OCR red ink. The red ink that is specified for the form allows scanners to drop the form template during the imaging of the paper.  This "cleaner" image is easier and faster to process with data capture automation such as ICR/OCR (Intelligent Character Recognition/Optical Character Recognition) software.  Your vendor may choose not to process claim forms that are submitted in black ink.
Q: Some payers give different instructions from those in the NUCC manual.  Which are correct?
A: The NUCC's goal in developing the 1500 Claim Form Reference Instruction Manual is to help standardize the manner in which the form is completed.  However, some payers will give their providers different instructions on how to complete certain item numbers on the form.  On the title page of the instruction manual, it states: The NUCC has developed this general instructions document for completing the 1500 Health Insurance Claim Form. This document is intended to be a guide for completing the 1500 Claim Form and not definitive instructions for this purpose. Any user of this document should refer to the most current federal, state, or other payer instructions for specific requirements applicable to using the 1500 Claim Form.

Proposed Timeline -- please make note of these recommended dates for transitioning to the revised (02/12) 1500 Claim Form

  • June 1, 2013 – Health plans, clearinghouses and other information support vendors to handle and accept the revised form.
  • June 1 – October 1, 2013 – Providers can use either the current form or the revised form. Health plans, clearinghouses and billing vendors to accept and process either version of the form.
  • October 1, 2013 – The current form is discontinued, and only the revised form is to be used. All rebilling of claims to be with the revised form from this date forward, even though earlier submissions may have been on the current form.

Early adopters of the Revised (02/12) 1500 Claim Form may choose to transition to the form earlier, based on trading partner agreement.  The NUCC strongly recommends that providers contact their health plans, clearinghouses, and/or vendors before submitting a claim with the revised form.

If you have questions or would like more information about the new CMS-1500 Form, please contact:

New Medical Forms

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