In the 1960s, there were a number of different claim forms and coding systems required by third-party payers to communicate information regarding procedures and services to agencies concerned with insurance claims. There was, however, no standardized form for physicians and other health care providers to report health care services. Therefore, the American Medical Association (AMA) embraced an assignment in the 1980s to work with the Centers for Medicare & Medicaid Services (CMS; formerly known as HCFA), and many other payer organizations through a group called the Uniform Claim Form Task Force to standardize and promote the use of a universal health claim form. As a result of this joint effort, the 1500 Claim Form is accepted nationwide by most insurance entities as the standard claim form/attending physician statement for submission of medical claims.
The Uniform Claim Form Task Force was replaced by the National Uniform Claim Committee (NUCC) in the mid 1990s. The NUCC’s goal was to develop the NUCC Data Set (NUCC-DS), a standardized data set for use in an electronic environment, but applicable to and consistent with evolving paper claim form standards. The NUCC continues to be responsible for the maintenance of the 1500 Claim Form. Although many providers now submit electronic claims, many of their software/hardware systems depend on the existing 1500 Claim Form in its current image.
SCOPE OF INSTRUCTIONS
This NUCC Reference Instruction Manual provides specific instructions on how to complete the 1500
Claim Form. Instructions and information provided align with the Accredited Standards Committee X12
(ASC X12) Health Care Claim: Professional (837), 005010X222 Technical Report Type 3 (5010) and 005010X222A1 Technical Report Type 3 (5010A1). 5010 and 5010A1 are collectively referred to as “5010A1” in this manual.
The 1500 Claim Form instructions were initially approved by the NUCC in November 2005. The NUCC continues to research the type of data that are typically reported, as well as the required data elements that may apply to public and private payers. Therefore, the instructions have and will continue to evolve. Updated versions of this instruction manual are released each July. The ultimate goal of the NUCC is to develop standardized national instructions. The end result may require additional changes to the 1500 Claim Form in the future.
The instructions in this manual are not specific to any applicable public or private payer. Refer to specific instructions issued by your payer, clearinghouse, and/or vendor for further clarification of reporting requirements.
The 1500 Claim Form may also be used to report patient encounter data to federal, state, and/or other public health agencies. Refer to instructions issued by these agencies for further clarification of reporting requirements.
The Form CMS-1500 is the standard paper claim form to bill Medicare Fee-For-Service (FFS) Contractors when a paper claim is allowed. In addition to billing Medicare, the 837P and Form CMS-1500 may be suitable for billing various government and some private insurers.
The 1500 Health Insurance Claim Form (1500 Claim Form) answers the needs of many health care payers.
It is the basic paper claim form prescribed by many payers for claims submitted by physicians, other providers, and suppliers, and in some cases, for ambulance services.
Health Insurance Claim Form - CMS-1500 (05/12)