Important! An update has been made to the information contained on this web page. This page has been retained for archival purposes only. Please refer to the December 2013 article, Revised time line for new CMS-1500 (02/12) claim form, for the latest information.

The National Uniform Claim Committee (NUCC) has approved an updated version of its 1500 Health Insurance ClaimForm (CMS-1500 claim form). The new claim form, which goes into effect January 6, 2014, will accommodate reportingneeds for ICD-10 as well as align with data captured on electronic 837P transactions. The primary change is that thenumber of diagnosis codes that can be reported has been increased from 4 to 12 (see sample below).

IBC will accept both the old (08/05) and new (02/12) claim forms from January 6 through March 31, 2014. From theperiod of April 1 through October 1, 2014, we will look to see which providers are still submitting old forms and completeoutreach and education. Effective October 1, 2014, IBC will no longer accept the old (08/05) claim form.

The NUCC has released an updated 1500 Health Insurance Claim Form Reference Instruction Manual, which is available under the 1500 Claim Form tab on their website at www.nucc.org.

Forms can be purchased through office supply stores, local printing companies, or by calling the U.S. GovernmentPrinting Office at 1-866-512-1800.

If you have any questions, please contact your Network Coordinator.