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 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
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.
• Change Request Form