The National Uniform Claim Committee (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.
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: firstname.lastname@example.org
Phone: 800-482-9367 ext. 58029 Government Printing Office 800-512-1800 http://bookstore.gpo.gov/catalog/government-forms-phone-directories
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.
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