OMB Approval of the 02/12 1500 Claim Form

The NUCC is pleased to announce the approval of the Version 02/12 1500 Health Insurance Claim Form (1500 Claim Form) that accommodates reporting needs for ICD-10 and aligns with requirements in the Accredited Standards Committee X12 (ASC X12) Health Care Claim: Professional (837P) Version 5010 Technical Report Type 3. The Office of Management and Budget (OMB) has approved the 1500 Claim Form under OMB Number 0938-1197.

During its work, the NUCC was made aware by the health care industry of two priorities that were included in the revisions to the 1500 Claim Form. The first was the addition of an indicator in Item Number 21 to identify the version of the diagnosis code set being report, i.e., ICD-9 or ICD-10. The need to identify which version of the code set is being reported will be important during the implementation period of ICD-10. The second priority was to expand the number of diagnosis codes that can be reported in Item Number 21, which was increased from 4 to 12. Additional revisions will improve the accuracy of the data reported, such as being able to identify the role of the provider reported in Item Number 17 and the specific dates reported in Item Number 14.

Here is the PDF of the revised 1500 form, including the template and grid versions:
• 02/12 1500 Claim Form

Note
This PDF version of the form may not print to its exact specifications and should not be used for claims submissions.

To receive copies of the 02/12 1500 Claim Form, contact:

Your current forms supplier;
TFP Data Systems: This email address is being protected from spambots. You need JavaScript enabled to view it. or 800-482-9367 ext. 58029; or
The Government Printing Office: http://bookstore.gpo.gov/catalog/government-forms-phone-directories or 800-512-1800

TFP and the Government Printing Office will have the print files and specifications available as of June 20, 2013.

The following change log shows all changes between the 08/05 version and 02/12 version of the form.
• 02/12 1500 Form Change Log

The following is the NUCC instruction manual for the 02/12 1500 Claim Form:
• v1.1 0613 0212 NUCC 1500 Instruction Manual

Transition Timeline

The NUCC will be reviewing its initial proposed implementation timeline and will seek input from its members, including Medicare. An announcement will be made once the NUCC has finalized its transition timeline. In the meantime, organizations should begin work on the programming and implementation needs for the revised 1500 Claim Form.

Providers will need to check with their payer and/or clearinghouses to determine when they will begin to accept the revised forms.

FAQs

Check the NUCC’s FAQs for information about commonly asked questions about the 1500 Claim Form. The FAQs will be updated periodically.

Announcement

Here is the announcement of the final approval of the revised form.
• 02/12 1500 Claim Form Approval Announcement

Questions about the DSMO Process?

The Designated Standards Maintenance Organizations (DSMO) have created a presentation ?Understanding the HIPAA Processes? to provide information on the HIPAA transactions, code sets, and operating rules processes under HIPAA. The presentation was developed to satisfy an industry need to have in one concise document the process of how to request changes to HIPAA mandated standards.

The presentation is available here: DSMO: Understanding the HIPAA Process

The DSMO includes three American National Standards Institute (ANSI) Accredited standard development organizations ? Accredited Standards Committee (ASC) X12, Health Level Seven (HL7) International, and the National Council for Prescription Drug Programs (NCPDP), and three data content organizations ‐ the American Dental Association (ADA) Dental Content Committee (DeCC), National Uniform Billing Committee (NUBC), and National Uniform Claim Committee (NUCC). The DSMO reviews change requests to the HIPAA designated standards and requests for new standards and code sets to be adopted.

Who Are We?

The National Uniform Claim Committee (NUCC) is a voluntary organization that replaced the Uniform Claim Form Task Force in 1995. The committee was created to develop a standardized data set for use by the non-institutional health care community to transmit claim and encounter information to and from all third-party payers. It is chaired by the American Medical Association (AMA), with the Centers for Medicare and Medicaid Services (CMS) as a critical partner. The committee is a diverse group of health care industry stakeholders representing providers, payers, designated standards maintenance organizations, public health organizations, and vendors.

The NUCC was formally named in the administrative simplification section of the HIPAA of 1996 as one of the organizations to be consulted by the American National Standards Institute's accredited SDOs and the Secretary of HHS as they develop, adopt, or modify national standards for health care transactions. As such, the NUCC is intended to have an authoritative voice regarding national standard content and data definitions for non-institutional health care claims in the United States. The NUCC's recommendations in this area are explicitly designed to complement and expedite the work of the Accredited Standards Committee Electronic Data Interchange (ASC X12N) in complying with the provisions of P.L. 104-191.

The NUCC is comprised of the key parties affected by health care electronic data interchange (EDI) - those at either end of a health care transaction, generally payers and providers. Criteria for membership include a national scope and representation of a unique constituency affected by health care EDI, with an emphasis on maintaining or enhancing the provider/payer balance. Each committee member is intended to represent the perspective of the sponsoring organization and the applicable constituency. Representatives are responsible for communicating information between the committee and the group(s) they represent.