Updates to the V5.0 7/17 1500 Instruction Manual
May 11, 2018
The NUCC has released updates to its V5.0 07/17 1500 Health Insurance Claim Form Reference Manual. The updates revise instructions, add qualifiers, and add examples for reporting additional claim information in Item Number 19.
The changes go into effect immediately and will be included in the next release of the 1500 instruction manual. The complete list of changes made to the instruction manual since its release is available on the "1500 Instructions" page under the "1500 Claim Form" tab.
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.
NUCC Releases January Taxonomy Code Set Update
January 2, 2018
The NUCC has released the semi-annual update to the Health Care Provider Taxonomy code set, which will go into effect on April 1, 2018. The complete code set 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.
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.