Health Insurance Claim Form Nucc

From the provider viewpoint non uniform data elements have caused significant frustration claims billing and processing delays and rejections.

Health insurance claim form nucc. This billing guide is designed to assist with the completion of the cms 1500 claim form. This document is intended to be a guide for completing the 1500 claim form and not definitive instructions for this purpose. The purpose of this manual is to help standardize nationally the manner in which the form is being completed. Patient s or authorized person s signature i authorize the release of any medical or other information necessary to.

Other claim id designated by nucc c. The current version of the instructions for the 02 12 1500 claim form was released in july 2020. The uniform claim form task force was replaced by the national uniform claim committee nucc in the mid 1990s. 1500 claim form reference instruction manual.

1500 health insurance claim form reference instruction manual v 02 12 updated july 2019. As a result of this joint effort the 1500 claim form is accepted nationwide by most insurance entities as the standard claim form attending physician statement for submission of medical claims. The nucc has developed this general instructions document for completing the 1500 claim form. The nucc is responsible for maintaining the integrity of the data sets and physical layout of the hard copy 1500 claim form.

Insurance plan name or program name yes. It is the basic paper claim form prescribed by many health plans for claims submitted by physicians and suppliers and in some cases for ambulance services. Submit only the red drop out approved cms 1500 02 12 claim form. The committee was created to develop a standardized data set for use by the non institutional health care community to transmit claim and encounter information to and from all third party payers.

The national uniform claim committee nucc is a voluntary organization that replaced the uniform claim form task force in 1995. Yes complete items 9 9a and 9d. Read back of form before completing signing this form. The 1500 health insurance claim form answers the needs of many health payers.

The nucc has developed a 1500 reference instruction manual detailing how to complete the claim form. Download the fillable hcfa 1500 claim form that is both a fillable and or printable medical claim form that will provide insurance illness and injury information for medical services claims. Cms 1500 02 12 claim form. The basic paper claim form currently used by health care professionals and suppliers to bill insurance carriers for services provided to patients is the.

Any user of this document should refer to the most current federal state or other payer instructions for specif ic requirements applicable to using the 1500 claim form. The 1500 health insurance claim form 1500 claim form is in the public domain. An individual physician s federal tax identification number issued by the internal revenue service.