New 1500 Claim Form Approved by OMB

August 27, 2013

On August 6, 2013, the National Uniform Claim Committee (NUCC) announced that the Office of Management and Budget (OMB) approved the 1500 Claim Form under OMB Number 0938-1197. This change is only for the paper claim form. It does NOT change the electronic (837P - Version 5010) form. These changes are being made to more closely tie the paper claim form to the electronic 5010 update which happened last year.

The implementation schedule has been set and approved by both the Centers for Medicare and Medicaid Services (CMS) and the NUCC. The table below highlights key dates for all providers who use the 1500 paper claim form:

January 6, 2014 Both private insurance carriers and Medicare will begin receiving and processing paper claims submitted on the revised CMS 1500 claim form (version 02/12).
January 6 2014 - March 31, 2014 Dual use period during which private insurance and Medicare receive and process paper claims submitted on either the old CMS 1500 claim form (version 08/05) or the new form (version 02/12).
April 1, 2014 Version 08/05 is discontinued. Only paper claims on the new form (Version 02/12) will be accepted by both private insurance and Medicare.

Christine Taxin
36 Abington Avenue
Ardsley New York 10502
United States of America