As previously communicated, the National UniformClaim Committee (NUCC) has approved anupdated version of its 1500 Health Insurance ClaimForm (CMS-1500 claim form). The new claimform (02/12), which went into effect January 6,2014, accommodates reporting needs for ICD-10and aligns with data captured on electronic 837transactions.

As of April 1, 2014, IBC will receive and processpaper claims submitted only on the new CMS-1500(02/12) claim form. Any paper claims submitted usingthe old version of the form (08/05) will be rejected.

Note: CMS-1500 (02/12) claim forms can bepurchased through office supply stores, local printingcompanies, or by calling the U.S. GovernmentPrinting Office at 1-866-512-1800.

Resources available

For more information about the key changes thatwere made to the CMS-1500 claim form, pleaserefer to the detailed article in the March 2014 editionof Partners in Health Update. For claims submissionaddresses by product, please refer to our payer IDgrids on the Electronic Data Interchange page of our website.

To assist you in submitting claims using the newCMS-1500 (02/12) claim form, we have revised ourCMS-1500 toolkit to accommodate the updatedversion of the form. Download this toolkit, titledClaims submission toolkit for proper electronic andpaper claims submissions.

This toolkit contains the latest information on electronicand paper claims submissions, a sample CMS-1500(02/12) claim form, key fields, loop and data elements,and resources for finding additional information.

The NUCC has also published an updated 1500 HealthInsurance Claim Form Reference Instruction Manual,which is available under the 1500 Claim Form tab onthe NUCC website.

If you have any questions, please contact your NetworkCoordinator.