HCFA 1500 02/12 Claim Form

The most recent version of the HCFA 1500 claim form was approved by the National Uniform Claim Committee (NUCC) in February 2012 (version 08/05 to version 02/12).

Effective April 1, 2014, any paper claim submitted to payers must be submitted on the HCFA 02/12 claim form.

Grab a sample of the form here - HCFA 02/12 Claim Form

HCFA 1500 02/12 Changes

While not many of the HCFA boxes were modified, it's important to identify which ones did and why. The most significant adjustment was made to HCFA box 21 "Diagnosis Codes". Providers are now able to send 12 diagnosis codes instead of 4. They are also able to indicate whether the claim contains ICD-9 or ICD-10 codes.

Listed below are detailed descriptions of what changed along with before & after screenshots of the HCFA boxes.

• Upper left corner - Black and white QR (Quick Response) code replaced the rectangular 1500 symbol
• Upper left corner - Changed version from 08/05 to 02/12
• HCFA Box 1
  • Changed "TRICARE CHAMPUS" to "TRICARE"
  • Changed "Sponser's SSN" to "ID#/DoD#"
  • Changed "SSN" to "ID#"
  • Changed "ID" to "ID#"

  08/05

  

  02/12

  
• HCFA Box 8
  • Changed title from "PATIENT STATUS" to "RESERVED FOR NUCC USE"
  • Relationship/Emplyeed/Student Status has been removed - not reported in 837P format

  08/05

  

  02/12

  
• HCFA Box 9b
  • Changed title from "OTHER INSURED'S DATE OF BIRTH & SEX" to "RESERVED FOR NUCC USE" - not reported in 837P format

  08/05

  

  02/12

  
• HCFA Box 9c
  • Changed title from "EMPLOYER'S NAME OR SCHOOL NAME" to "RESERVED FOR NUCC USE" - not reported in 837P format

  08/05

  

  02/12

  
• HCFA Box 10d
  • Changed title from "RESERVED FOR LOCAL USE" to "CLAIM CODES (Designated by NUCC)"

  08/05

  

  02/12

  
• HCFA Box 11b
  • Changed title from "EMPLOYER'S NAME OR SCHOOL NAME" to "OTHER CLAIM ID (Designated by NUCC)" - not reported in 837P format
  • The box was split into two fields (see dotted line). Left-hand side is reserved for a 2-byte qualifier

  08/05

  

  02/12

  
• HCFA Box 14
  • Changed title from "DATE OF CURRENT:" to "DATE OF CURRENT ILLNESS, INJURY, or PREGNANCY (LMP)"
  • The right side arrow and text has been removed
  • The box was split into two fields (see dotted line). Right-hand side is reserved for a 3-byte qualifier

  08/05

  

  02/12

  
• HCFA Box 15
  • Changed title from "IF PATIENT HAS HAD SAME OR SIMILAR ILLNESS. GIVE FIRST DATE" to "OTHER DATE"
  • The box was split into two fields (see the two dotted lines). Left-hand side is reserved for a 3-byte qualifier

  08/05

  

  02/12

  
• HCFA Box 17
  • The box was split into two fields (see the dotted line). Left-hand side is reserved for a 2-byte qualifier

  08/05

  

  02/12

  
• HCFA Box 19
  • Changed title from "RESERVED FOR LOCAL USE" to "ADDITIONAL CLAIM INFORMATION (Designated by NUCC)"

  08/05

  

  02/12

  
• HCFA Box 21
  • Part of the title was changed from "(Relate Items 1, 2, 3 or 4 to Item 24E by Line)" to "Relate A-L to service line below (24E)"
  • Added "ICD Ind." (see two dotted lines) to accommodate a 1-byte indicator
  • The diagnosis code labels have been changed from numeric (1. 2. 3. 4.) to alpha (A. B. C. D. E. F. G. H. I. J. K. L.)
  • The visible decimal has been removed
  • The box has been expanded to accept 12 diagnosis codes instead of only 4

  08/05

  

  02/12

  
• HCFA Box 22
  • The title on the left has Changed from "MEDICAID RESUBMISSION CODE" to "RESUBMISSION CODE"

  08/05

  

  02/12

  
• HCFA Box 30
  • The title on the left has Changed from "BALANCE DUE" to "Rsvd for NUCC use" - not reported in 837P format

  08/05

  

  02/12

  

Transitioning to the Updated Form

While the transition deadline (April 1, 2014) to implement the revised HCFA 1500 02/12 form has already passed, there are many providers using systems that currently don't have this functionality. With ICD-10 deadline of Oct 1, 2015 fast approaching, it's important to evaulate your system and trading partners to see what changes you will need to make to ensure uninterrupted cash flow for your office.

Here are some typical Health Care scenarios and what you need to know.

Medical Billing System (in-house)

Ensuring that your software is able to handle the new ICD-10 codes is imperative. Depending on the age of your Medical Billing Software, uprades might not even be possible. A new Medical Billing system might be in order. Do your research to see which solution is best for your office.

Medical Billing

If you have choosen a Medical Billing company to do your billing then you need to ensure that they are ready for ICD-10 and all of their trading partners are ready.

Clearinghouse

Using a Clearinghouse has many advantages. They are the one entity that are able to accept data that isn't in the HIPAA 837 format. So while you might still be using the old 08/05 form, that doesn't mean that you'll be able to send ICD-10 codes. If you haven't already, call them today to see what options they have available.

Once you're finished doing your research and if you find any of the above scenarios who aren't ready for ICD-10 by now, it might be time for you to consider other solutions who are ready.