The National Uniform Claim Committee (NUCC) has released the revised version of the 1500 Health Insurance Claim Form (version 08/05) that accommodates the reporting of the National Provider Identifier (NPI). The Office of Management and Budget (OMB) has approved the 1500 Claim Form under OMB Number 0938-0999 with an initial expiration date of June 30, 2007. The Centers for Medicare & Medicaid Services (CMS) will begin the renewal process for the form in January 2007.The final 1500 Claim Form, with the CMS OMB number in the bottom right-hand corner, is posted on the NUCC website, www.nucc.org. The form on the website may not print to its exact specifications unless using a special printer programmed to print forms. Print specifications are available in Appendix A of the Reference Instruction Manual, also posted on the NUCC website.
To receive copies of the revised form with the print specifications, please contact TFP Data Systems at firstname.lastname@example.org or 800-482-9367 ext. 1770, or your forms distributor
Arrangements are still being made with the Government Printing Office regarding their distribution of the revised form.
The new 1500 Reference Instruction Manual detailing how to complete the form is available on the NUCC website. The instruction manual has been updated to Version 1.3 7/06.