"New" CMS-1500: WCMS-1500CS-12 Date of Implimentation Unknown (as of August 2013)

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.

 

Header: The barcode was removed.

Header: The language “PLEASE DO NOT STAPLE IN THIS AREA” was removed from the left-hand side.

Header: The rectangle with “1500” was added in black ink to the left-hand side.

Header: The title “HEALTH INSURANCE CLAIM FORM” was moved from the lower, right-hand side to the left-hand side.

Header: The language “APPROVED BY NATIONAL UNIFORM CLAIM COMMITTEE 08/05” was added to the left-hand side.

Header: The language “TEST VERSION – NOT FOR OFFICIAL USE” was added to the right-hand side. This language will be removed when the form is approved by OMB.

Box 1: “TRICARE” was added above “CHAMPUS”.

Box 1: Under CHAMPVA, “VA File #” was changed to “Member ID#”.

Box 17a: The box was split in half length-wise.

Box 17a: This area was shaded. This box will accommodate other ID numbers.

Box 17a: Two vertical lines were added. This field will accommodate a two byte qualifier for other ID numbers.

Box 17b: This field was added.

Box 17b: Two vertical lines were added with the “NPI” label. This field will accommodate the NPI number.

Box 21: The lines after the decimal point in items 1, 2, 3, and 4 were extended to accommodate four bytes.

Box 24: The line with the alpha indicators was removed. The alpha indicators were moved next to the respective titles in the title fields.

Box 24: The line numbers to the left of Box 24 were increased in size and centered with each line.

Box 24: Each of the six lines were split length-wise and shading was added to the top portion of each line. This area is to be used for the reporting of supplemental information.

Box 24: Vertical line separators on each of the six lines have been removed from the shaded area,               except for the lines before Boxes 24I and 24J.

Box 24C: “Type of Service” was removed. This field is now titled “EMG”.

Box 24D: The field became wider by three bytes.

Box 24D: Shading was added vertically between “CPT/HCPCS” and “MODIFIER”.

Box 24D: Vertical lines were added in the unshaded “MODIFIER” section to accommodate four                  sets of two bytes.

Box 24E: The title was changed from “DIAGNOSIS CODE” to “DIAGNOSIS POINTER”.

Box 24E: The field was decreased by three bytes.

Box 24G: This field was increased by one byte.

Box 24H: This field was decreased by one byte.

Box 24I: The title was changed from “EMG” to “ID. QUAL.”.

Box 24I: A horizontal line was added length-wise across the field separating the shaded and unshaded portions of the field.

Box 24I: The label “NPI” was added in the unshaded portion of the field.

Box 24J: The title was changed from “COB” to “RENDERING PROVIDER ID. #”. 1500 Claim                            Form Change Log – 11/29/05

Box 24J: A dotted horizontal line was added length-wise across the field separating the shaded and unshaded portions of the field. The NPI number is to be reported in the unshaded field. An other ID number can be reported in the shaded field.

Box 24K: This field, “RESERVED FOR LOCAL USE”, was removed.

Box 32: Boxes 32a and 32b were added at the bottom.

Box 32a: This field was added to accommodate reporting of the NPI number and is indicated by the shaded label of “NPI”.

Box 32b: This shaded field was added to accommodate the reporting of other ID numbers.

Box 33: Parentheses were added after the title to indicate the location for reporting the telephone number.

Box 33: Boxes 33a and 33b were added at the bottom.

Box 33a: The title of this field was changed from “PIN#” to “a.”.

Box 33a: A shaded label of NPI was added to the box to indicate the reporting of the NPI number.

Box 33b: The title was changed from “GRP#” to “b.” to accommodate the reporting of other ID numbers.

Box 33b: The field was shaded.

Footer: The language “NUCC Instruction Manual available at: www.nucc.org” was added to the left-hand side.

Footer: The OMB approval numbers were removed and the language “OMB APPROVAL                 PENDING” was added. The numbers will be added after approval has been received by OMB.

Back: The following language was added in the last line at the bottom of the form: “This address     is for comments and/or suggestions only. DO NOT MAIL COMPLETED CLAIM  FORMS TO THIS ADDRESS.”

 

Courtesy of HMBA