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Chicago, IL.  The National Uniform Claim Committee (NUCC) announces the release of the new version of the CMS-1500 Health Insurance Claim Form (version 08/05) that accommodates the reporting of the National Provider Identifier (NPI). This new version will update the existing CMS-1500 Claim Form (version 12/90), often referred to as the HCFA-1500. (Click here to order online now)


Why is it 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 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. 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 (08/05) 1500 Claim Form.


October 1, 2006March 31, 2007: Providers can use either the current (12/90) version or the revised (08/05) version of the CMS-1500 Claim Form.


April 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) 1500 Claim Form.


The following is the proposed Medicare implementation timeline: the new Form CMS-1500 (08/05) will be effective for optional use starting January 2, 2007 through March 30, 2007, but will be required starting April 2, 2007.


Providers will need to check with their payer and/or clearinghouses to determine when they will begin to accept the revised forms.



Forms Hotline is one of the industry's largest distributors of healthcare claim forms including the CMS/HCFA-1500, ADA, and UB92 claim forms.  Forms Hotline maintains inventories of these products in four locations to help minimize freight costs. The warehouse locations for these products include:


Atlanta, GA
Edison, NJ
Coldwater, OH
Sacramento, CA


These products are offered in a wide variety of versions and sizes (8-1/2" x 11", 9-1/2" x 11" and 9-1/2" x 14"). Ink colors include OCR red and black (old versions of forms).

1-part laser cut-sheet
2-part carbonless unit set
1-part continuous
2-part carbonless and carbon interleaved continuous
3-part carbonless continuous
4-part carbonless continuous

Here is a change log that identifies the changes to the new CMS-1500 (08/05).

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-handside.
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.
Box 17b This field was added
Box 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:” 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.”



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