CMS 1500 Claim Forms - Frequently Asked Questions

Why is the CMS 1500 form changing?
The CMS-1500 contains a number of improvements and enhancements that include better alignment with the electronic HIPAA ASC X12N 837-non Institutional Transaction Standard. The New CMS 1500 paper claim form will be able to accommodate the reporting of the National Provider Identifier (NPI) Number. The NPI will be a single provider identifier, replacing the different provider identifiers healthcare systems currently use for each health plan with which you do business. Using the CMS 1550, the NPI Identifier, which implements a requirement of the Health Insurance Portability and Accountability Act of 1996 (HIPAA), must be used by all HIPAA covered entities, which are health plans, healthcare clearinghouses, and healthcare providers.

What are the timelines for the transition of the new CMS-1500 Claim Form?
October 1, 2006: Health plans, clearinghouses, and other information support vendors must be ready to handle and accept the revised CMS 1500 (08/05) Claim Form.

October 1, 2006 – February 1, 2007: Providers can use either the current (12/90) version or the revised (08/05) version of the CMS-1500 Claim Form.

February 1, 2007: The current (12/90) version of the CMS-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) CMS 1500 Claim Form.

Will the CMS 1500 form name change?
The form will be known as the CMS-1500 (REV. 08/05).

Will there be new OMB numbers given to the CMS 1500 forms?
Because the CMS 1500 form has been revised and is used by a number of government agencies such as Medicare, Medicaid, CMS, CHAMPUS and TRICARE, it requires a new OMB number. Approval is pending on the CMS 1500 revised form.

For the most current information regarding CMS 1500 forms (08/05 version) changes, please visit the NUCC.org site.
Location is followed by the Change
Header: The barcode was removed
Header: Language “please do not staple in this area” was removed from left side.
Header: The rectangle with “1500” was added in black ink to the left-hand side.
Header: The title “HEALTH INSURANCE CLAIM FORM” was moved from the lower, right side to the left-hand side.
Header: Language “ APPOVED NY NATIONAL UNIFORM CLAIM COMMITTEE 08/05” was added to the left-hand side.
Box 1: “TRICARE” was added above “CHAMPUS”
Box 1: Under CHAMPUS, VA File #” was change to “Member ID#”.
Box 17a: The box was split in half length-wise.
Box 17a: This area was shaded. This box will accommodate other ID numbers.
Box 17a: Two vertical lines were added. This field will accommodate two byte qualifier for other ID numbers.
17b: This field was added
17b: Two vertical lines were added with the “NPI” label. This field will accommodate the NPI number.
Box 21: The lines after decimal points in items 1, 2, 3, & 4 were extended to accommodate four bytes.
Box 24: The line with the alpha indicators was removed. Alpha indicators were moved next to respective titles in the title fields.
Box 24: Line numbers to the left of box 24 were increased in size and centered with each line.
Box 24: Each of the six lines were split length-wise and shading was added to the top portion of each line. This area is to be used for the reporting of supplemental information.
Box 24: Vertical lines separates on each of the six lines have been removed from the shaded area, except for the lines before 24I and 24J.
Box 24C: “Type of Service” was removed. This field is now titled “EMG”.
Box 24D: The field became wider by three bytes. Shading was added vertically between “CPT/HCPCS” and “MODIFIER”.
Box 24D: Vertical Lines were added in the un-shaded “MODIFIER” section to accommodate four sets of two bytes.
Box 24E: The title was changed from “DIAGNOSIS CODE” to “DIAGNOSIS POINTER”.
Box 24E: The field was decreased by three bytes.
Box 24G: This field was increased by one byte.
Box 24H: This field was decreased by one byte.
Box 24I: The title was changed from “EMG” to “ID. QUAL”.
Box 24I: A horizontal line was added length-wise across the field separating the shaded and un-shaded portions of the field.
Box 24I: The label “NPI” was added in the un-shaded portion of the field.
Box 24J: The title was changed from “COB” to “RENDERING PROVIDER ID. #”.
Box 24J: A dotted horizontal line was added length-wise across the field separating the shaded and un-shaded portions of the field. The NPI number is to be reported in the un-shaded field. Other ID number can be reported in the shaded field.
Box 24K: This field, “RESERVED FOR LOCAL USE”, was removed.
Box 32: Boxes 32a and 32b were added at the bottom.
Box 32a: This field was added to accommodate reporting of the NPI number and is indicated by the shaded label of “NPI”.
Box 32b: This shaded field was added to accommodate the reporting of other ID numbers.
Box 33: Parentheses were added after the title to indicate the location for phone number.
Box 33: Boxes 33a & 33b were added at the bottom.
Box 33a: The title of this field was changed from “PIN” to “a.”.
Box 33a: A shaded label of NPI was added to the box to indicate the reporting of the NPI number.
Box 33b: The title was changed from “GRP#” to “b.” to accommodate other ID numbers.
Box 33b: the field was shaded.
Footer: The language “NUCC Instruction Manual available at: www.nucc.org” was added to left-hand side.
Footer: The OMB approval numbers were removed and the language “OMB APPROVAL PENDING: was added. The new “OMB” numbers will be added after approval is complete.
Back: The following language was added in the last line at the bottom of the form. “This address is for comments and suggestions only. DO NOT MAIL COMPLETED CLAIM FORMS TO THIS ADDRESS.”

Frequently Asked Questions About The CMS 1500 Forms