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New HCFA 1500 CMS-1500 (Health Insurance Claim Form) APPROVED OMB-0938-0999 FORM CMS-1500 (08-05) NUCC revised the Form CMS-1500. The new 08-05 version of the CMS-1500 form was effective June 29, 2007 and is the standard claim form used by a non-institutional provider or supplier to bill Medicare contractors and durable medical equipment contractors when a provider qualifies for a waiver from the Administrative Simplification Compliance Act (ASCA) requirement for electronic submission of claims.
Form CMS-1500 (08-05) replaced the CMS-1500 (12-90) version. Medicare will reject any 12-90 version forms received.