Blank CMS 1500 (HCFA 1500) Paper Claim Forms - Laser Format
The Current CMS 1500 (HCFA 1500) Health Insurance Claim Form APPROVED OMB-0938-0999 CMS-1500 (08-05)
A new CMS 1500 claim form was released by the U.S. Centers for Medicare and Medicaid Services (CMS). The new CMS-1500 (02/12) will replace this current form (08/05).
The updated CMS implementation timeline* for government payments, such as Medicare and Medicaid, is as follows:
January 6, 2014: Medicare begins receiving and processing paper claims submitted on the revised CMS-1500 claim form (02/12)
January 6 - March 31, 2014: Dual-use period during which Medicare continues to receive and process paper claims submitted on either version of the form
April 1, 2014: The current claim form (08/05) is discontinued; Medicare receives and processes paper claims submitted only on the revised CMS-1500 claim form (02/12)
*These dates are tentative and subject to change.
The 08/05 version of the CMS-1500 forms was revised by the NUCC effective June 29, 2007 and replaced the CMS-1500 12/90 version. The CMS1500 Form is the standard paper claim form used by a non-institutional provider or supplier to bill Medicare, durable medical equipment contractors, and private health insurance.
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