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

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.