Frequently Asked Questions (FAQs)
Revised 1500 Claim Form (02/12) FAQs
Why was the 1500 Claim Form changed?
The form was revised to align the paper form with some of the changes in the electronic Health Care Claims: Professional (837), 005010X222 Technical Report Type 3 (5010) and 005010X222A1 Technical Report Type 3 (5010A1).
What is the latest revision?
The most recent is “Revision 02/12.”
What are the specific changes that were made to the form?
The most significant changes were the addition of eight diagnosis codes in Item Number 21 and the addition of the QR Code at the top left of the form. For a complete list of the changes from the current (08/05) version to the revised (02/12), view the Change Log Document (PDF)
[link to http://www.nucc.org/images/stories/PDF/version_0212_1500_change_log.pdf] posted on the NUCC website.
Why was the QR Code added to the top of the form?
The QR Code includes a link to an NUCC landing page that provides information about the form. It also helps align the form for the reader.
How can I obtain the revised form?
The proposed changes have not yet been approved by the Office of Management and Budget (OMB) but are expected by soon. For more information, contact firstname.lastname@example.org.
Timeline for the New CMS-1500 Form
Please take note of these dates for transitioning to the new (02/12) form:
January 6, 2014: Private insurance carriers and Medicare begin receiving and processing paper claims submitted on the revised CMS-1500 claim form (02/12).
January 6 – March 31, 2014: Dual-use period during which private insurance carriers and Medicare continue to receive and process paper claims submitted on either version of the form.
April 1, 2014: The current claim form (08/05) is discontinued; all private insurance carriers and Medicare receives and processes paper claims submitted only on the revised CMS-1500 claim form (02/12).
Remember: Providers will need to check with their payer and/or clearinghouses to determine when they will begin to accept the revised forms. During the transition period, we will continue to inventory and sell our current stock of the CMS-1500 (08/05 version).
Where are completed forms sent?
Completed claim forms are to be sent to the insurance company, payer, or other entity responsible for paying the claim.
Can information be preprinted on our claim forms so it doesn’t have to be reentered each time?
The information preprinted on forms should be left to each individual provider and should be information that will remain the same regardless of the payer the forms are being submitted to. One example may be the Billing Provider Information. Providers should check with their payers to make sure they accept claim forms with preprinted information.
What font size should I use when completing the revised form?
The recommended font size is 10.
Can only forms printed in red ink be used or can providers use a form that is copied or printed in black?
For the form to be read by a scanner, the form must be in OCR red ink. The red ink that is specified for the form allows scanners to drop the form template during the imaging of the paper. This "cleaner" image is easier and faster to process with data capture automation such as ICR/OCR (Intelligent Character Recognition/Optical Character Recognition) software. Your vendor may choose not to process claim forms that are submitted in black ink.
Some payers give different instructions from those in the NUCC manual. Which are correct?
The NUCC's goal in developing the 1500 Claim Form Reference Instruction Manual is to help standardize the manner in which the form is completed. However, some payers will give their providers different instructions on how to complete certain Item Numbers on the form.
On the title page of the instruction manual, it states:
The NUCC has developed this general instructions document for completing the 1500 Health Insurance Claim Form. This document is intended to be a guide for completing the 1500 Claim Form and not definitive instructions for this purpose. Any user of this document should refer to the most current federal, state, or other payer instructions for specific requirements applicable to using the 1500 Claim Form.
How can I track my order?
To track you order, go to My Account
, log in, and you will have the option to View Your Orders.
What if I did not create an account during checkout, or I called the order in? Can I still track my order?
Yes, you can. If you did not create an account, please email us for your user name. You will then be able to retrieve your password at the email address used when you checked out. Once logged in, you can view the status of your orders online.
What if my order doesn't have a tracking number but says it's Completed?
This usually happens if the order has been shipped by USPS as we do not save tracking numbers for most of those shipments. You can always ask us, though, and we will share it with you if we have it. The UPS shipments that do not have a tracking number are usually packages of 100 of the CMS forms shipped out of our WA location. Our UPS system automatically sends a tracking notification email to the email address provided during checkout, so we don't update our online system with that information unless asked. Please contact us if you need assistance.
Where can I find the Place of Service Codes for my CMS 1500 form?
It is available on the CMS.gov website at:
If it is no longer on this page, just do a search on the cms.gov website for "place of service codes" and it should bring up the most current information.
Can CMS 1500 forms be hand written?
Yes, in many instances, the CMS 1500 form can be handwritten. It depends on the payor/insruance company that you're turning the form into for payment.
Will justCMS1500forms.com accept checks in payment of an order?
No, orders must be paid with a credit card.
What is the return policy?
We will accept all current stock forms and envelopes back that have not been opened or used, providing there's a reasonable reason for return. Returns requests can be denied at our sole discretion. Upon return approval, all returned goods are subject to a 15% restocking fee. Shipping and handling charges will not be refunded. Credits will be issued upon receipt of the goods. Customer is responsible for shipping the product back at their expense. We strongly recommend using a shipping method that requires a signature upon delivery so you can have proof of the return. All returns must have an R/A number displayed on the return product or delivery will be refused. Email customer care
for an R/A number.
Can I change my shipping address once the order is in process?
Yes, but we cannot guarantee we can catch the order in time. Our system is set up so that most orders ship within 24 hours of your order being placed, some leave as soon as 1 hour after your order is placed, depending on the timing. Once the order has been shipped, if the order shipped to the address you provided to us, there will be an additional $10 charge to change the address. UPS charges an "intercept fee" to change the address on a shipment once it's been given to them, which we pass along to you. We strive to ensure all orders are delivered to you as quickly and accurately as possible.
What is normal turnaround time for CMS 1500 forms?
The normal turnaround time for our CMS 1500 forms' shipments is as follows: Full carton orders of CMS 1500 forms ship the same day or the very next day. CMS 1500 forms should be delivered within 1 week after placement of order. Packages of CMS 1500 forms are shipped from Washington (state). For more information please contact us.
Will the CMS 1500 form name change?
The form will be known as the CMS-1500 (REV 02/12).
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.