Updated 1500 Claim Form - 837P Map
August 13, 2018
The NUCC has updated its map of the 02/12 1500 Claim Form to the X12 837 Health Care Claim: Professional (837P) Version 5010/5010A1 electronic transaction. The substantive change in the map is the addition of the 837P REF01 and REF02 data elements in the mapping of 1500 claim form Item Number 19. The map is available under the 1500 Claim Form tab.
The 1500 Claim Form - 837P map is a simplified crosswalk of the 1500 Item Numbers to the corresponding data elements in the 837P 5010/5010A1 transaction. Users of the map will need to refer to the NUCC's 1500 Reference Instruction Manual and the X12 Technical Report Type 3 (TR3) for more information about the data elements and reporting requirements.
July 2018 Release of Updates to Taxonomy and Provider Characteristics Code Sets
July 2, 2018
The NUCC has released the semi-annual update to the Health Care Provider Taxonomy code set, which will go into effect on October 1, 2018. The complete code set, including the list of new and modified codes, is available under the "Code Sets" tab. The PDF download version of the code set is also available there.
When reviewing the Health Care Provider Taxonomy code set online, revisions made since the last release can be identified by the color code; new items are green.
Additionally, seven changes have been made to the Provider Characteristics code set; six new codes have been added and one code has been revised. The complete code set is available under the "Code Sets" tab.
NUCC Annual Release of 2018 1500 Instruction Manual
June 29, 2018
The NUCC has released its annual, updated version of its 1500 Health Insurance Claim Form Reference Instruction Manual. The updated instruction manual, Version 6.0 7/18, goes into effect immediately and is available under the 1500 Claim Form tab.
All changes that were made to the instructions following the July 2017 release have been incorporated into this version of the instruction manual. A change log showing all of the updates is also available under the 1500 Claim Form tab. Any interim changes, clarifications, or corrections to the instructions following this release will be posted on the NUCC website.
Do NOT email, fax, or mail completed 1500 Claim Forms to the NUCC. The NUCC does not process claims. Send completed forms to the appropriate payer.
Results of NUCC Survey on 1500 Form Usage
January 29, 2018
The NUCC conducted a survey from October to November 2017 to gather information on the current usage in the industry of the 1500 Health Insurance Claim Form (1500 Form), both as a paper form and as a print image. The results of the survey are available here.
Overall, the survey found that there continues to be significant use of the 1500 Form within the industry. The top reasons for using the 1500 Form among all stakeholders were 1) attachments; 2) coordination of benefits; 3) workers' compensation, property and casualty, and auto claims; 4) claims for specific services; and 5) primary claims.
The NUCC plans to use the information from this survey in its general work on the professional claim and its data content. This survey is not an indication of any specific changes being considered for the 1500 Form.
1500 Claim Form Renewed by OMB
April 10, 2017
The Office of Management and Budget (OMB) has completed its review and renewed the 1500 claim form for use by government programs, most notably Medicare. The form has been renewed in its current format, with no changes to the OMB number, data fields, or other text on the form.
Forms with the 02/12 NUCC approval date and OMB number 0938-1197 (02-12) remain in effect and valid.
The renewal of the 1500 claim form by OMB occurs every three years and is outside the scope of the NUCC's work.
Resources for Implementing the 02/12 1500 Claim Form
Payers may begin accepting the 02/12 1500 Claim Form as of January 6, 2014. The following resources will assist your organization in implementing the revised form:
- Understanding the Changes to the 0212 1500 Claim Form presentation
- Updating to the 0212 1500 Claim Form
Submitters of the form should follow up with their specific payer(s) regarding their transition timeline information.
Questions about the DSMO Process?
The Designated Standards Maintenance Organizations (DSMO) have created a presentation "Understanding the HIPAA Processes" to provide information on the HIPAA transactions, code sets, and operating rules processes under HIPAA. The presentation was developed to satisfy an industry need to have in one concise document the process of how to request changes to HIPAA mandated standards.
The presentation is available here: DSMO: Understanding the HIPAA Process
The DSMO includes three American National Standards Institute (ANSI) Accredited standard development organizations ‐ Accredited Standards Committee (ASC) X12, Health Level Seven (HL7) International, and the National Council for Prescription Drug Programs (NCPDP), and three data content organizations ‐ the American Dental Association (ADA) Dental Content Committee (DeCC), National Uniform Billing Committee (NUBC), and National Uniform Claim Committee (NUCC). The DSMO reviews change requests to the HIPAA designated standards and requests for new standards and code sets to be adopted.
Who Are We?
The National Uniform Claim Committee (NUCC) is a voluntary organization that replaced the Uniform Claim Form Task Force in 1995. The committee was created to develop a standardized data set for use by the non-institutional health care community to transmit claim and encounter information to and from all third-party payers. It is chaired by the American Medical Association (AMA), with the Centers for Medicare and Medicaid Services (CMS) as a critical partner. The committee is a diverse group of health care industry stakeholders representing providers, payers, designated standards maintenance organizations, public health organizations, and vendors.
The NUCC was formally named in the administrative simplification section of the HIPAA of 1996 as one of the organizations to be consulted by the American National Standards Institute's accredited SDOs and the Secretary of HHS as they develop, adopt, or modify national standards for health care transactions. As such, the NUCC is intended to have an authoritative voice regarding national standard content and data definitions for non-institutional health care claims in the United States. The NUCC's recommendations in this area are explicitly designed to complement and expedite the work of the Accredited Standards Committee Electronic Data Interchange (ASC X12N) in complying with the provisions of P.L. 104-191.
The NUCC is comprised of the key parties affected by health care electronic data interchange (EDI) - those at either end of a health care transaction, generally payers and providers. Criteria for membership include a national scope and representation of a unique constituency affected by health care EDI, with an emphasis on maintaining or enhancing the provider/payer balance. Each committee member is intended to represent the perspective of the sponsoring organization and the applicable constituency. Representatives are responsible for communicating information between the committee and the group(s) they represent.