08/05 1500 Claim Form

The following information is for the Version 08/05 1500 Claim Form. Verify with your payer if they are continuing to accept this old version of the claim form or if you need to use the current 02/12 1500 Claim Form.
• 08/05 Claim Form
• Version 9.1 5/14 Instruction Manual – This is the final version of the 08/05 1500 Claim Form instruction manual.
• 08/05 1500 - 837P Crosswalk

NUCC Data Set

The NUCC Data Set is a compilation of each data element in the 837P and its relationship to the 1500 Claim Form Item Numbers. The NUCC Data Set was previously released in 2003. It was revised in January 2009 to accommodate the changes to the 08/05 version of the 1500 Claim Form.

Users of the NUCC Data Set will need to refer to the NUCC’s 1500 Reference Instruction Manual for more specific information on the 1500 Claim Form and the X12 837 Health Care Claim: Professional 4010A1 implementation guide for more information on the electronic transaction.


NUCC Data Set

Several principles underlie the NUCC’s goals and implementation approach, including:

  1. Standardization requires broad-based consensus among key parties. The NUCC is a broad, public and private-sector collaboration governed by formal Bylaws.
  2. Data sets for institutional and professional (non-institutional) claims/encounters must be coordinated. To foster coordination the NUCC works closely with the NUBC.
  3. The professional (non-institutional) uniform data set and associated attachments requirements should constitute the full extent of the data required by any public or private payer to process a claim/encounter.

The end product of the NUCC’s efforts is one standard data set, with complete and unambiguous data definitions, for use in the electronic environment, but applicable to and consistent with evolving paper claim form standards.

The NUCC will continue to work to optimize, as necessary, coordination of implementation within the health care industry, working with ASC X12 as required, to resolve data maintenance and standards issues between the electronic claim transaction and the 1500 Claim Form. Consistency between the outputs of the NUCC and ASC X12 will be emphasized, as well as consistency between the NUCC and NUBC.