Completed claim forms are to be sent to the insurance company, payer, or other entity responsible for paying the claim.  The NUCC does not process claims, so completed claim forms should not be sent to the NUCC.  Completed claim forms received by the NUCC will be returned to the provider or patient identified on the form.

To obtain a copy of the form PDF and printing standards, contact either of the following:

TFP Data Systems: This email address is being protected from spambots. You need JavaScript enabled to view it. or 800-482-9367 ext. 1770

Government Printing Office: 800-512-1800

Forms printers are warned not to create a form without obtaining the PDF and printing standards, as this may lead to poor quality of the form and may result in rejection of the form if the data is not aligned properly.

 

Any information that you have pre-printed on your forms should be information that will remain the same regardless of the payer you are submitting to.  One example may be the Billing Provider Information.  You may also want to check with a couple of your payers to make sure they can accept claim forms with pre-printed information.

The recommended font size is 10.

If your current supplier does not have the 08/05 form, have them get in touch with the Government Printing Office or TFP Data Systems for the revised form's PDF/negative so they can begin printing the revised form. Their contact information is:

• TFP Data Systems: This email address is being protected from spambots. You need JavaScript enabled to view it. or 800-482-9367 ext. 1770
• Government Printing Office: 800-512-1800 or http://bookstore.gpo.gov/collections/cms1500-form.jsp 

If you need a supplier, do a web search using the key words "CMS 1500" and you should get a list of suppliers. You can check their website or contact them to see if they have the revised forms.

If your current vendor will be unable to support the 08/05 1500, do a web search using the key words "CMS 1500 software" and you should get a list of vendors. You can check their website or contact them to see if they have software to support the 08/05 1500.

In order for the form to be read by a scanner, the form must be in 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.

The NUCC's goal in developing the 1500 Claim Form Reference Instruction Manual is to help standardize nationally the manner in which the form is completed. We do recognize, however, that 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.

My organization wants to insert its own specific instructions into the NUCC Reference Instruction Manual. Can we do this?

No. Any payer-specific or other organization-specific modifications to instructions must be maintained in a separate document that references the NUCC Reference Instruction Manual.

The NUCC Data Set provides a crosswalk between the 837P and the 1500 Claim Form. The NUCC has also created a 1500-837P Crosswalk.  Both documents are available under the "1500 Claim Form" tab on the NUCC website.  

No. The form continues to accommodate the reporting of only six services. The shaded areas of lines 1-6 are to accommodate supplemental information being reported for the service.