NUCC 1500 - 837P Crosswalk

Below is a link to the NUCC 1500 - 837P Crosswalk.

The NUCC's 1500 Claim Form Map to the X12N Health Care Claim: Professional (837) is a simplified map of the 1500 Item Number fields to the corresponding data elements in the 837P 5010/5010A1 transaction. This document is intended to be used in conjunction with the NUCC Data Set; however the NUCC Data Set will not be updated until the completion of the revisions to the 1500 form.

Users of the 1500 - 837P Crosswalk will need to refer to the NUCC's 1500 Reference Instruction Manual for mre specific information on the 1500 Claim Form and the X12N Health Care Claim: Professional 5010/5010A1 implementation guide for more information on the electronic transaction.

 

NUCC Data Set

Below is a link to the NUCC Data Set.

The NUCC Data Set is a compilation of each data element in the 837P and its relationship to the 1500 Claim Form Item Numbers. The NUCC Data Set was previously released in 2003. It has been revised to accommodate the changes to the 08/05 version of the 1500 Claim Form.

Users of the NUCC Data Set will need to refer to the NUCC’s 1500 Reference Instruction Manual for more specific information on the 1500 Claim Form and the X12 837 Health Care Claim: Professional 4010A1 implementation guide for more information on the electronic transaction.

Background

NUCC Data Set

Several principles underlie the NUCC’s goals and implementation approach, including:

  • Standardization requires broad-based consensus among key parties. The NUCC is a broad, public and private-sector collaboration governed by formal Bylaws.
  • Data sets for institutional and professional (non-institutional) claims/encounters must be coordinated. To foster coordination the NUCC works closely with the NUBC.
  • The professional (non-institutional) uniform data set and associated attachments requirements should constitute the full extent of the data required by any public or private payer to process a claim/encounter.

The end product of the NUCC’s efforts is one standard data set, with complete and unambiguous data definitions, for use in the electronic environment, but applicable to and consistent with evolving paper claim form standards.

The NUCC will continue to work to optimize, as necessary, coordination of implementation within the health care industry, working with ASC X12 as required, to resolve data maintenance and standards issues between the electronic claim transaction and the 1500 Claim Form. Consistency between the outputs of the NUCC and ASC X12 will be emphasized, as well as consistency between the NUCC and NUBC.

Requests for changes to the NUCC Data Set may be submitted via email to This email address is being protected from spambots. You need JavaScript enabled to view it..

NUCC 1500 - 837P Crosswalk

The NUCC's 1500 Claim Form Map to the X12N Health Care Claim: Professional (837) is a simplified map of the 1500 Item Number fields to the corresponding data elements in the 837P 5010/5010A1 transaction.

Users of the 1500 - 837P Crosswalk will need to refer to the NUCC's 1500 Reference Instruction Manual for more specific information on the 1500 Claim Form and the X12N Health Care Claim: Professional 5010/5010A1 implementation guide for more information on the electronic transaction.

 

1500 Instruction Manual Changes

The following is a complete list of changes that have been made to the 9.0 7/13 version of the 1500 Instruction Manual since its release in July 2013 and will be included in the next published version of the manual.
• 08/05 102013 1500 Instructions Change Log (PDF)

1500 Claim Form Reference Instruction Manual

The NUCC has developed a 1500 Reference Instruction Manual detailing how to complete the claim form. The purpose of this manual is to help standardize nationally the manner in which the form is being completed.

The current version of the instructions for the 02/12 1500 Claim Form was released in July 2017.
• Version 5.0 7/17 1500 Instruction Manual

DO NOT email, fax, or mail completed 1500 Claim Forms to the NUCC. The NUCC does not process claims. Send completed forms to the appropriate payer.

1500 Instruction Manual Changes

The following is a change log of updates that were made between the version 4.0 7/16 1500 Instruction Manual and the version 5.0 7/17 1500 Instruction Manual.
• 072017 v.4.0 Instruction Manual Change Log

Previous Versions

Previous releases of the Instruction Manual:
• Version 4.0 7/16 1500 Instruction Manual
• Version 3.0 7/15 0212 1500 Instruction Manual
• Version 2.0 7/14 0212 1500 Instruction Manual
• Version 1.1 7/13 0212 1500 Instruction Manual

Change Requests

If you would like to request a change for the 1500 Instruction Manual, please complete the following form. The same form can be used to submit requests for changes to the 1500 Claim Form layout. 

Email completed forms to the NUCC at This email address is being protected from spambots. You need JavaScript enabled to view it. (Do NOT use the Change Request Form to ask general instruction questions or request an instruction manual. General questions and requests for instruction manuals can be emailed to the above address.)
• Change Request Form

 

1500 Claim Form

1500 Claim Form 02/12 Version

Use of the Version 02/12 1500 Claim Form went into effect April 1, 2014.

The following is the PDF of the revised 1500 form, including the template and grid versions: (The form image may not print to scale.  This image of the form should not be used for claims submission. This image should also not be used by forms printers to create the form.)

• 02/12 Claim Form

DO NOT email, fax, or mail completed 1500 Claim Forms to the NUCC. The NUCC does not process claims. Send completed forms to the appropriate payer.

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 866-512-1800

02/12 1500 Form Change Log

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

1500 Claim Form Change Requests

To request changes to the 1500 Claim Form layout, please fill out the form below and email it to This email address is being protected from spambots. You need JavaScript enabled to view it.. The same form can be used to submit requests for changes to the NUCC 1500 Reference Instruction Manual.

1500 Form Change Request Form

Background Information

The NUCC replaced the Uniform Claim Form Task Force, which was co-chaired by the AMA and CMS and resulted in the development of the 1500 Claim Form, a single paper claim form for use by all third-party payers. With the transition of the medical community to electronic data interchange and the proliferation of data element definitions among various payers, it became essential that an organization be established to maintain uniformity and standardization in these areas. The NUCC is responsible for maintaining the integrity of the data sets and physical layout of the hard copy 1500 Claim Form.

From the provider viewpoint, non-uniform data elements have caused significant frustration, claims billing and processing delays, and rejections. From the payer viewpoint, claims that are not in the required format may be resubmitted several times before they can be processed. The result is a very labor-intensive and costly business practice for providers and payers.

Through an iterative process, the NUCC used existing implementation guides, data dictionaries and results from ongoing standardization efforts within the health care industry to consolidate the many current data sets into one set.  The NUCC continues to work to optimize, as necessary, coordination of implementation within the health care industry, working with ASC X12N as required, to resolve data maintenance and standards problems that arise from the NUCC's work.