New CMS 1500 (Form 02/12)

Description

New CMS 1500 Claim Form (02/12)

The New CMS 1500 Claim Form Ships Starting 07/08/2013. Approved CMS 1500 Form (02-12). OMB-0938-1197 FORM 1500 (02-12) New Edition

Transition Timeline

The NUCC has approved a transition timeline for the version 02/12 1500 Health Insurance Claim Form (1500 Claim Form). In June, the NUCC (National Uniform Claim Committee) announced the approval of the updated 1500 Claim Form that accommodates reporting needs for ICD-10 and aligns with requirements in the Accredited Standards Committee X12 (ASC X12) Health Care Claim: Professional (837P) Version 5010 Technical Report Type 3. The NUCC approved the following transition timeline at its in-person meeting in Chicago on August 1, 2013.

• January 6, 2014: Payers begin receiving and processing paper claims submitted on the revised 1500 Claim Form (version 02/12).
• January 6 through March 31, 2014: Dual use period during which payers continue to receive and process paper claims submitted on the old 1500 Claim Form (version 08/05).
• April 1, 2014: Payers receive and process paper claims submitted only on the revised 1500 Claim Form (version 02/12).

This timeline aligns with Medicare’s transition timeline.

New CMS 1500 (Form 02/12) options:

• 1 Part Laser – 2500 sheets
• 2 Part Continuous Perforated Dot Matrix – 1000 sheets
• 1 Part Continuous Perforated Dot Matrix  – 2500 sheets

Learn more about the New CMS 1500 (Form 02/12) Claim Form