The NUCC Approves a Revised 1500 Health Insurance Claim Form 3/27/2012 The NUCC is releasing the revised version of the 1500 Health Insurance Claim Form (version 02/12) that will accommodate Version 5010 837P changes and ICD-10 implementation. This revised version will update the current 1500 Claim Form (version 08/05), often referred to as the "HCFA 1500" or "CMS 1500." The following are the various documents related to the revised 1500 Claim Form. These documents include: The revised 1500 Claim Form can be printed from the above PDF, but will not print to its exact specifications unless using a special printer programmed to print forms. To receive copies of the revised form for testing purposes, please contact TFP Data Systems at JRMagdaleno@tfpdata.com. The revised 1500 Claim Form has been submitted to the Centers for Medicare & Medicaid Services (CMS) for approval for use with federal programs, such as Medicare. The revised form will also undergo approval by the Office of Management and Budget (OMB) prior to being finalized. Therefore, the PDF formats of the revised form posted above currently have no OMB approval numbers. The unofficial version of the revised form is being released now for testing and transition preparation purposes only. It is not to be used for the official purpose of claims submission at this time. During the CMS and OMB approval processes, the revised 1500 Claim Form will be released for two public comment periods. These comment periods will be announced in the Federal Register. Although the NUCC does not anticipate major additional changes being made to the revised form, it is possible that changes could be made as part of the approval process. Once the revised 1500 Claim Form has been officially approved by OMB, the NUCC will release the final version of the form. A timeframe of when the approval will be finalized is not known at this time. The NUCC recommended timeline for transitioning to the 0212 version of the 1500 Claim Form is as follows: - June 1, 2013 – Health plans, clearinghouses, and other information support vendors are ready to handle and accept the revised (02/12) 1500 Claim Form.
- June 1 – October 1, 2013 – Providers can use either the current (08/05) or the revised (02/12) 1500 Claim Form. Health plans, clearinghouses, and billing vendors are able to accept and process either version of the form.
- October 1, 2013 – The current (08/05) 1500 Claim Form is discontinued; only the revised (02/12) 1500 Claim Form is to be used. All rebilling of claims will be on the revised (02/12) 1500 Claim Form from this date forward, even though earlier submissions may have been on the current (08/05) 1500 Claim Form.
The NUCC began revision work on the 1500 Claim Form in 2009. The goal of this work was to align the paper form with some of the changes in the electronic Health Care Claim: Professional (837), 005010X222 Technical Report Type 3 (5010) and 005010X222A1 Technical Report Type 3 (5010A1). During the revision work, consideration was given to different approaches to revising the form. The NUCC decided to proceed with making "minor changes" to the current form, which was defined as no physical changes to the existing form lines or underlying layout of the form. The limited scope of changes was based on feedback from NUCC members and their constituents who wanted to limit the amount of work and costs that would be required to implement a revised 1500 Claim Form. Two public comment periods were held, one in October 2009 and the other in June 2011, to solicit feedback on the proposed changes. The revised version was voted on and approved by the NUCC in February 2012. For more information on the revision of the 1500 Claim Form, contact Nancy Spector, NUCC Chair, at nancy.spector@ama-assn.org. |
