1500 Health Insurance Claim Form Change Log 6/17/2013 The

1500 Health Insurance Claim Form Change Log
6/17/2013
The following is the list of changes between the 1500 Claim Form 08/05 version and the 02/12 version.
Location
Change
Header
Replaced 1500 rectangular symbol with black and white two-dimensional QR Code (Quick Response Code).
Header
Added “(NUCC)” after “APPROVED BY NATIONAL UNIFORM CLAIM COMMITTEE.”
Header
Replaced “08/05” with “02/12.”
Item Number 1
Changed “TRICARE CHAMPUS” to “TRICARE” and changed “(Sponsor’s SSN)” to “(ID#/DoD#).”
Item Number 1
Changed “(SSN or ID)” to “(ID#) under “GROUP HEALTH PLAN.”
Item Number 1
Changed “(SSN)” to “(ID#)” under “FECA BLK LUNG.”
Item Number 1
Changed “(ID)” to “(ID#)” under “OTHER.”
Item Number 8
Deleted “PATIENT STATUS” and content of field. Changed title to “RESERVED FOR NUCC USE.”
Item Number 9b
Deleted “OTHER INSURED’S DATE OF BIRTH, SEX.” Changed title to “RESERVED FOR NUCC USE.”
Item Number 9c
Deleted “EMPLOYER’S NAME OR SCHOOL.” Changed title to “RESERVED FOR NUCC USE.”
Item Number 10d
Changed title from “RESERVED FOR LOCAL USE” to “CLAIM CODES (Designated by NUCC).”
Item Number 11b
Deleted “EMPLOYER’S NAME OR SCHOOL.” Changed title to “OTHER CLAIM ID (Designated by NUCC).”
Added dotted line in the left-hand side of the field to accommodate a 2-byte qualifier.
Item Number 11d
Changed “If yes, return to and complete Item 9 a-d” to “If yes, complete items 9, 9a, and 9d.”
Item Number 14
Changed title to “DATE OF CURRENT ILLNESS, INJURY, or PREGNANCY (LMP).” Removed the arrow and
text in the right-hand side of the field. Added “QUAL.” with a dotted line to accommodate a 3-byte qualifier.
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Location
Change
Item Number 15
Changed title from “IF PATIENT HAS HAD SAME OR SIMILAR ILLNESS. GIVE FIRST DATE” to “OTHER
DATE.” Added “QUAL.” with two dotted lines to accommodate a 3-byte qualifier.
Item Number 17
Added a dotted line in the left-hand side of the field to accommodate a 2-byte qualifier.
Item Number 19
Changed title from “RESERVED FOR LOCAL USE” to “ADDITIONAL CLAIM INFORMATION (Designated by
NUCC).”
Item Number 21
Changed instruction after title from “(Relate Items 1, 2, 3 or 4 to Item 24E by Line)” to “Relate A-L to service
line below (24E).”
Item Number 21
Removed arrow pointing to 24E.
Item Number 21
Added “ICD Ind.” and two dotted lines in the upper right-hand corner of the field to accommodate a 1-byte
indicator.
Item Number 21
Added 8 additional lines for diagnosis codes. Evenly spaced the diagnosis code lines within the field.
Item Number 21
Changed labels of the diagnosis code lines to alpha characters (A – L).
Item Number 21
Removed the period within the diagnosis code lines.
Item Number 22
Changed title from “MEDICAID RESUBMISSION” to “RESUBMISSION.”
Item Number 30
Deleted “BALANCE DUE.” Changed title to “Rsvd for NUCC Use.”
Footer
Changed “APPROVED OMB-0938-0999 FORM CMS-1500 (08/05)” to “APPROVED OMB-0938-1197 FORM
1500 (02/12).”
Back
Updates to the language.
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