As previously communicated, the National UniformClaim Committee (NUCC) has approved an updatedversion of its 1500 Health Insurance Claim Form(CMS-1500 claim form). The new claim form (02/12),which went into effect January 6, 2014, accommodatesreporting needs for ICD-10 and aligns with datacaptured on electronic 837 transactions.

As of April 1, 2014, AmeriHealth will receive andprocess paper claims submitted only on the newCMS-1500 (02/12) claim form. Any paper claimssubmitted using the old version of the form (08/05)will be rejected.

Note: CMS-1500 (02/12) claim forms can be purchasedthrough office supply stores, local printing companies,or by calling the U.S. Government Printing Office at1-866-512-1800.

Resources available

For more information about the key changes that weremade to the CMS-1500 claim form, please refer tothe detailed article in the March edition of Partners inHealth Update. For claims submission addresses byproduct, please refer to our payer ID grids, which areavailable on the Electronic Data Interchange page of our website.

To assist you in submitting claims using the newCMS-1500 (02/12) claim form, we have revised ourCMS-1500 toolkit to accommodate the updatedversion of the form. Download this toolkit, titledClaims submission toolkit for proper electronic andpaper claims submissions.

This toolkit contains the latest information on electronicand paper claims submissions, a sample CMS-1500(02/12) claim form, key fields, loop and data elements,and resources for finding additional information.

The NUCC has also published an updated 1500 HealthInsurance Claim Form Reference Instruction Manual,which is available under the 1500 Claim Form tab onthe NUCC website.

If you have any questions, please contact your NetworkCoordinator or Hospital/Ancillary Services Coordinator.