02/12 Claim Form


Welcome to CollaborateMD's NUCC 1500 Claim Form training page. This page is specifically designed to quickly aid you in becoming knowledgeable in the 1500 Claim Form changes. The final approval of the 02/12 1500 Claim Form 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 Office of Management and Budget (OMB) has approved the 1500 Claim Form (click to read press release) under OMB Number 0938-1197.

Here is a sample of the revised 1500 form, this document includes the template and grid versions. Note: The PDF version of the form may not print to its exact specifications and should not be used for claims submissions.

NoteAs your software vendor we adhere to the changes in accordance with the new form and we are closely monitoring updates regarding testing dates for the new CMS-1500 form and we will be working closing with our clearinghouse (Change Healthcare) to be ready for implementation

About NUCC

The National Uniform Claim Committee (NUCC) is a voluntary organization that replaced the Uniform Claim Form Task Force in 1995. The committee was created to develop a standardized data set for use by the non-institutional health care community to transmit claim and encounter information to and from all third-party payers. It is chaired by the American Medical Association (AMA), with the Centers for Medicare and Medicaid Services (CMS) as a critical partner. The committee is a diverse group of health care industry stakeholders representing providers, payers, designated standards maintenance organizations, public health organizations, and vendors.

News & Announcements

Recent Announcements

  • New 1500 Transition Timeline Announced The NUCC has approved a transition timeline for the version 02/12 1500 Health Insurance Claim Form (1500 Claim Form).  In June, the NUCC announced the approval of the updated ...
    Posted Aug 13, 2013, 12:40 PM by Angelique Belot
  • NUCC Approval of the 02/12 1500 Claim Form Dear Users,The NUCC has announced the approval of the version 02/12 1500 Health Insurance Claim Form (1500 Claim Form) that supports the reporting needs for ICD-10 and ...
    Posted Aug 13, 2013, 12:42 PM by Angelique Belot
Showing posts 1 - 2 of 2. View more »
Tools & Resources
Frequently Asked Questions 

Find answers to your frequently asked questions related to 02/12/1500.

Find answers to your frequently asked questions related to 02/12/1500.
Downloads & Guides 
 v1.1 0613 0212 NUCC 1500 Instruction Manual

Provides specific instructions on how to complete the 1500 Claim Form.
 02/12 1500 Claim Form Map to X12 837P

A crosswalk of the 02/12 version 1500 Health Care Claim Form (1500 Claim Form) to the X12 837 Health Care Claim; Profession Version 5010/5010A1 electronic transaction.
 02/12 1500 Form Change LogThe Change Log shows all changes between the 08/05 version and 02/12 version of the form.