To accommodate ICD-10 reporting needs, the National Uniform Claim Committee (NUCC) has announced a change to Version 02/12 of the 1500 claim form. Payers will begin receiving and processing paper claims on the revised form on January 6, 2014, dual form use will be in effect through March 31 and only claims submitted on the revised form will be processed after April 1.
There are two main changes to the form. First, there is an indicator in Item 21 to identify the version of the diagnosis code set being used (ICD-9 or ICD-10). Second, the number of diagnosis codes that can be reported in Item 21 has been increased from four to 12.
Other changes to the form include:
- A QR code was added to the top of the form. If you have the necessary app on your smartphone and scan the code, it will take you to the NUCC website.
- The patient status in Item 8, the insured’s date of birth and sex in 9b, and the school or employer’s name in 9c and 11b were eliminated to better align the reporting requirements of the paper 1500 claim form with the electronic 837P transaction.
- Item 10d is now limited to the reporting of certain claim codes, such as condition codes.
- Item 11b is now “Other Claim ID” to create the ability to report a qualifier to indicate the type of number being reported.
- A qualifier was added to Item 14 to specifically identify which date is being reported.
- Item 15 is now “Other Date” to indicate which date is being reported.
- A qualifier was added to Item 17 to identify the role of the provider being reported.
- Item 19 was changed to “Additional Claim Information” to limit the use of it as an open text field.
- In Item 21, each service line can point to up to four diagnosis codes and the line labels have changed from numbers to letter to avoid confusion.
- Item 22 can now be used for resubmissions with any payer, not just Medicaid.
- “Balance Due” in Item 30 was eliminated to better align with the electronic 837P transaction.
Finally, a crosswalk between the 1500 claim form and the 837P is available on the NUCC website. It maps the 1500 item number fields to the corresponding data elements in 837P. NUCC notes the document is intended for use in conjunction with the NUCC Data Set, which will be updated on completion of the form 1500 revision.
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