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Revised CMS-1500 (02-12) Health Insurance Claim Forms and Envelopes

Edition/Year: Version 02/12
Publisher: TFP Data Systems
Form,
Item#: DS050114

CMS-1500 (version 02/12) Laser-Cut Sheet, White, 1,000 Sheet Carton

List Price: 44.95
AMA Member: 39.95

Your trusted source for the new CMS-1500 claim form (02/12). The CMS-1500 claim form has changed. On April 1, 2014, the current form (version 08/05) will be discontinued and all private insurance carriers and Medicare will only accept the new version (02/12).

Also Available LIST PRICE AMA MEMBER
Select CMS-1500 (version 02/12) Laser-Cut Sheet, White, 500 Sheet Carton 34.95 29.95
Select CMS-1500 (version 02/12) Laser-Cut Sheet, White, 250 Sheet Carton 24.95 19.95
Select CMS-1500 (version 02/12) 1-Part Continuous Form, White, 1,000 Sheet Carton 44.95 39.95
Select CMS-1500 (version 02/12) 2-Part Continuous Form, White/Canary, 1,000 Sheet Carton 50.95 45.95
Select CMS-1500 (version 02/12) 2-Part Snap-Apart Form, White/Canary, 500 Sheet Carton 61.95 56.95
Select Envelopes, #10.5: 500 Self-Seal - Use with new and old forms 34.5 27.5
Select Envelopes - Right Window, 9 x 12: 500 Jumbo - Use with the new and old forms 84.5 67.5

The National Uniform Claim Committee (NUCC) has released a revised CMS-1500 claim form (version 02/12) to replace the current form (version 08/05). The revisions to the form will better align the CMS-1500 with the changes in the electronic Health Care Claims. Use of the new form goes into effect on April 1, 2014. Both versions of the form are accepted between Jan. 6 and Mar. 31, 2014.

The CMS-1500 form accommodates reporting of the National Provider Identifier which must be used by all HIPAA-covered entity including health plans, healthcare clearinghouses and healthcare providers. The form is designed for processing on high speed Optical Character Recognition (OCR) scanning equipment and is printed with OCR red ink on 20# paper. Forms are 100% compliant and rejection-proof to ensure quicker payment by insurance companies. Forms are available in several laser-printed compatible formats and quantities.

Information about the NUCC and documentation related to the CMS-1500 form is available at nucc.org. Click on the links below to view:

Revised CMS-1500 form at a glance
Change log showing all changes between the 08/05 version and 02/12 version of the form
Instruction manual for the 02/12 1500 claim form detailing how to complete the claim form
1500 Claim Form: Frequently Asked Questions

 

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