Health Insurance Claim Form (CMS-1500)

formerly HCFA-1500

When must I begin using the new 1500 claim form?

The NUCC (National Uniform Claim Committee) has made modifications to its recommended timeline for transitioning to the revised 1500 Claim Form. The timeline is now:

October 1, 2006
Health plans, clearinghouses, and other information support vendors should be ready to handle and accept the revised (08/05) 1500 Claim Form.
October 1, 2006 - March 31, 2007
Providers can use either the current (12/90) version or the revised (08/05) version of the 1500 Claim Form.
April 1, 2007
The current (12/90) version of the 1500 Claim Form is discontinued; only the revised (08/05) form is to be used. All rebilling of claims should use the revised (08/05) form from this date forward, even though earlier submissions may have been on the current (12/90) 1500 Claim Form.

What are the changes to the 1500 claim form?

Changes include splitting of box 17a to provide for reporting of the NPI number or other identifying number. Similar changes were made to box 24I and box 33. Other changes are mostly minor such as removal of the bar code on the top of the form and the addition of Tricare above Champus. If you would like to review all of the changes, the National Uniform Claims Committee has a PDF file (2 pages / 16 KB.) of the changes to the 1500 form available on the NUCC site.

Are there instructions on how to use the new 1500 form?

Yes. The National Uniform Claims Committee has produced an instruction manual (PDF file: 54 pages / 2,203 KB. ) to give general guidance on the use of the new 1500 form.

Item No.	No. of Parts	Quantity/Ctn.	Price
C-770	Single Laser Sheets	500/ctn.	$11.00/ctn.
C-771	1-Part Continuous	2,000/ctn.	$41.00/ctn.
C-772	2-Part Continuous	1,000/ctn.	$42.00/ctn.

Universal Billing Form CMS-1450 (UB-04)

formerly UB-92

The NUBC is updating the UB-92; it will be replaced by the UB-04 paper form. During the period March 1, 2007 through May 22, 2007, providers that use paper forms for claim submission will be able to submit either the UB-92 or the UB-04 form. CMS expects to discontinue acceptance of UB-92 forms effective May 23, 2007. HIPAA requires submission of National Provider Identifiers (NPIs) on claims effective May 23, 2007, and the UB-92 does not have a field for reporting of NPIs. The dates of this transition period were established by the NUBC. Further information on the UB-92 and the UB-04 is available through the NUBC web site. A link is provided below. The UB-04 will retain the CMS-1450 designation.

Item No.	No. of Parts	Quantity/Ctn.	Price
C-780	Single Laser Sheets	500/ctn.	$11.00/ctn.
C-781	1-Part Continuous	2,000/ctn.	$41.00/ctn.
C-782	2-Part Continuous	1,000/ctn.	$42.00/ctn.

National Uniform Billing Committee (NUBC)

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