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NUCC 1500 Claim Form Frequently Asked Questions (FAQ's)

Why was the 1500 Claim Form changed?

The form was revised to align the paper form with some of the changes in the electronic Healthcare Claims: Professional (837), 005010X222 Technical Report Type 3 (5010) and 005010X222A1 Technical Report Type 3 (5010A1).

What is the latest revision? 

The latest is “Revision 02/12.”

When is it required?

April 1, 2014.

What are the specific changes that were made to the form?

The most significant changes were the addition of eight diagnosis codes in Item Number 21 and the addition of the QR Code at the top left of the form. 

Why was the QR code added to the top of the new form?

The QR code provides a link to an NUCC landing page that provides information about the form. It also helps align the form for the reader.

How can I obtain the revised 1500 forms?

The proposed changes have not yet been approved by the Office of Management and Budget (OMB) but is expected later in 2012/2013. Contact New Medical Forms at: admin@newmedicalforms.com to request form samples.

Where are completed forms sent?

Completed claim forms are to be sent to the insurance company, payer, or other entity responsible for paying the claim. 

Can information be pre-printed on our claim forms so it doesn't have to be reentered each time?

The information pre-printed on forms should be left to each individual provider and should be information that will remain the same regardless of the payer the forms are being submitting to. One example may be the Billing Provider Information. Providers should check with their payers to make sure they accept claim forms with pre-printed information.

What font size should I use when completing the revised 1500 claim form?

The recommended font size is 10.

Can only forms printed in red ink be used or can providers use a form that is copied or printed in black?

In order for the form to be read by a scanner, the form must be in OCR red ink. The red ink that is specified for the form allows scanners to drop the form template during the imaging of the paper. This "cleaner" image is easier and faster to process with data capture automation such as ICR/OCR (Intelligent Character Recognition/Optical Character Recognition) software. Your vendor may choose not to process claim forms that are submitted in black ink.

Some payers give different instructions than the NUCC manual. Which is correct?

The NUCC's goal in developing the 1500 Claim Form Reference Instruction Manual is to help standardize the manner in which the form is completed. However, some payers will give their providers different instructions on how to complete certain item numbers on the form. On the title page of the instruction manual, it states: The NUCC has developed this general instructions document for completing the 1500 Health Insurance Claim Form. This document is intended to be a guide for completing the 1500 Claim Form and not definitive instructions for this purpose. Any user of this document should refer to the most current federal, state, or other payer instructions for specific requirements applicable to using the 1500 Claim Form.

Is there an Instruction Manual detailing how to complete the new claim form?

Yes, you can visit the NCUU web site to review the current and past Instruction Manuals.

How can I receive copies of the 02/12 1500 Claim Form? 

To receive copies of this form contact:



Updated: 02/01/2014