CMS-1500 Claim Forms (version 02/12) by PMIC

The latest format! CMS-1500 insurance claim form with peel and stick mailing label. New revised (02/12) format with NO bar code and split provider identifier fields.
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  • Item#: CMS891
  • Edition: New Format
  • Format: Continuous or Snap Apart
  • ISBN#: See Below
  • Availability: In Stock
  • Product Notes:
  • Ships standard ground only. Usually ships in 48 hours.

Revised CMS-1500 form (version 02/12). No bar code, mandatory April 1, 2014.

Item # Description Price Qty
89130 CMS-1500 1-Part Continuous Feed Computer - Mailing Label (1,000 box) $79.95
89110 CMS-1500 1-Part Continuous Feed Computer (1,000 box) $34.95
89135 CMS-1500 2-Part Continuous Feed Computer - Mailing Label (1,000 box) $104.95
89115 CMS-1500 2-Part Continuous Feed Computer (1,000 box) $69.95
89125 CMS-1500 2-Part Snap Apart (500 box) $54.95
89120 CMS-1500 3-Part Continuous Feed Computer (1,000 box) $79.95
89105 CMS-1500 Laser Sheets (1,000 box) $44.95

These are revised CMS-1500 (02/12) forms, and are mandatory for all claims filed on or after April 1, 2014.

The bar code has been dropped from all versions of the form.

The National Uniform Claim Committee (NUCC) maintains the CMS-1500 paper claim form and makes updates according to health care industry requirements. NUCC recently announced that the health care industry will transition to a revised version of the CMS-1500 paper claim form in early 2014. Notable changes include:

  • Indicators added for differentiating between ICD-9-CM and ICD-10-CM diagnosis codes
  • The number of possible diagnosis codes expanded to 12
  • Qualifiers added to identify provider roles: Ordering, Referring, Supervising

The tentative implementation timeline is as follows:

  • January 6, 2014 — Medicare begins receiving and processing paper claims submitted on the revised CMS-1500 claim form (version 02/12).
  • January 6, 2014 through March 31, 2014 — Dual-use period during which Medicare continues to receive and process paper claims submitted on the old CMS-1500 claim form (version 08/05), as well as on the new revised CMS-1500 claim form (version 02/12).
  • April 1, 2014 — Medicare receives and processes paper claims submitted only on the revised CMS-1500 claim form (version 02/12).

The above timeline is pending finalization and is subject to change.

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