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Coming Soon: Revised CMS-1500 Paper Claim Form (Version 02/12)

November 18, 2013

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.

On June 10, 2013, the White House Office of Management and Budget (OMB) approved the revised CMS-1500 paper claim form, known as OMB-0938-1197 FORM 1500 (02-12). You'll see this new code at the bottom of the revised version.

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)


For consistency with electronic transactions, the revised paper form also aligns with the requirements of the Accredited Standard Committee X12 (ASC X12) Health Care Claim: Professional (837P) Version 5010 Technical Reports Type 3 (TR3s).* Several fields on the previous paper form were removed for CMS-1500 (version 02/12) since they are not reported in the 837 transaction.

The tentative implementation timeline is as follows:

  • Jan. 6, 2014 − Medicare begins receiving and processing paper claims submitted on the revised CMS-1500 claim form (version 02/12).
  • Jan. 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. BCBSNM will comply with the mandated timeline for implementation of the revised CMS-1500 paper claim form.

Please note: Blue Cross and Blue Shield of New Mexico encourages all providers to use electronic claim submission. This can help streamline your administrative processes, help protect your patients' information, and may result in faster claim processing and payment.

To learn more visit the Claims and Eligibility/Electronic Commerce section.

For additional information on the CMS-1500 claim form, visit the NUCC website at nucc.org . Please share this information with your practice management software vendor and/or your billing service or clearinghouse, if applicable.

*The Washington Publishing Company (WPC) is an independent publisher of implementation guides recognized by the Centers for Medicare & Medicaid Services (CMS) as the industry standard. To purchase TR3s, visit the WPC website at wpc-edi.com .