As previously communicated, Independence only accepts the updated version of
the 1500 Health Insurance Claim Form (CMS-1500 claim form). The current version
(02/12), which went into effect in January 2014, accommodates reporting needs
for ICD-10 and aligns with data captured on electronic 837 transactions.
Updates were recently made to our Claims Submission Toolkit for Proper
Electronic and Paper Claims Submissions. This toolkit was created to
assist you in submitting claims using the CMS-1500 (02/12) claim form and
contains the latest information on electronic and paper claims submissions, a
sample CMS-1500 (02/12) claim form, key fields, loop and data elements, and
resources for finding additional information.
In addition, the National Uniform Claim Committee (NUCC) recently released
an updated 1500 Health Insurance Claim Form Reference Instruction
Manual. To request more information, send an email to NUCC.
Note: CMS-1500 (02/12) claim forms can be purchased through office
supply stores, local printing companies, or by calling the U.S. Government
Printing Office at 1-866-512-1800.