To accommodate ICD-10 reporting needs, the National Uniform Claim Committee (NUCC) changed Version 02/12 of the 1500 claim form.

To begin with, payers will begin receiving and processing paper claims on the revised form on January 6, 2014. Further, dual form use will be in effect through March 31 and only claims submitted on the revised form will be processed after April 1.
Because of this, there are two main changes to the form. First, there is an indicator in Item 21 to identify the version of the diagnosis code set being used (ICD-9 or ICD-10). Second, the number of diagnosis codes that can be reported in Item 21 has been increased from four to 12.

As a result, changes to the form include:

  • changes to cms 1500 formThe form now has a QR code which will take you to the NUCC website
  • The patient status in Item 8, the insured’s DOB and sex in 9b, and the employer’s name in 9c and 11b were eliminated to better align the reporting requirements of the paper 1500 claim form with the electronic 837P transaction.
  •  Certain claim condition codes limit reporting of Item 10d. 
  • Item 11b is now “Other Claim ID” to create the ability to report a qualifier to indicate the type of number the provider reports.
  • A qualifier was added to Item 14 to specifically identify the reported date.
  • Item 15 is now “Other Date” to indicate the date the provider reports.
  • NUCC added a qualifier to Item 17 to identify the role of the provider being reported.
  •  To limit the use of open text field NUCC, Item 19 was changed to “Additional Claim Information”
  • In Item 21, each service line can point to up to four diagnosis codes and the line labels have changed from numbers to letter to avoid confusion.
  • The section in Item 22 can now be used for resubmissions with any payer,  not just Medicaid.
  • “Balance Due” in Item 30 was eliminated to better align with the electronic 837P transaction.

Finally, keep in mind

Last but not least,  a crosswalk between the 1500 claim form and the 837P is on the NUCC website. It maps the 1500 item number fields to the corresponding data elements in 837P. In addition, NUCC notes the document is intended for use in conjunction with the NUCC Data Set, which will be updated on completion of the form 1500 revision. As a final point, keep the transition as easy as possible, and look into coding and diagnosis code tools.
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Last Updated on November 13, 2020