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OMB Approves the Version 02/12 1500 Health Insurance Claim Form

June 17, 2013

Chicago, IL – The NUCC is pleased to announce the approval of the Version 02/12 1500 Health Insurance Claim Form (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 Office of Management  and Budget (OMB) has approved the 1500 Claim Form under OMB Number 0938-1197.  

During its work, the NUCC was made aware by the health care industry of two priorities that  were included in the revisionsto the 1500 Claim Form. The first was the addition of an indicator  in Item Number 21 to identify the version of the diagnosis code set being report, i.e., ICD-9 or  ICD-10. The need to identify which version of the code set is being reported will be important  during the implementation period of ICD-10. The second priority was to expand the number of  diagnosis codes that can be reported in Item Number 21, which was increased from 4 to 12.  Additional revisions will improve the accuracy of the data reported, such as being able to identify  the role of the provider reported in Item Number 17 and the specific dates reported in Item  Number 14. 

Form Availability 
Print vendors should contact either of the following to obtain the 02/12 1500 Claim Form print  files and specificationsfor print production:

TFP Data Systems
Email: 1500form@tfpdata.com
Phone: 800-482-9367 ext. 58029

Government Printing Office

TFP and the Government Printing Office will have the print files and specifications available as  of June 20, 2013.

Users of the 1500 Claim Form should contact their forms supplier for the updated forms.

Transition Timeline
The NUCC will be reviewing its initial proposed implementation timeline and will seek input  from its members, including Medicare. An announcement will be made once the NUCC has  finalized its transition timeline. In the meantime, organizations should begin work on the  programming and implementation needs for the revised 1500 Claim Form.  

Providers will need to check with their payer and/or clearinghouses to determine when they will  begin to accept the revised forms.

About the NUCC
The 1500 Claim Form is maintained by the NUCC. The NUCC is a voluntary organization of  health care industry stakeholders representing providers, payers, designated standards  maintenance organizations, public health organizations, and vendors.  For more information on the 1500 Claim Form, visit the NUCC website, www.nucc.org or email info@nucc.org.