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27 Jul 2017 CMS-1500 (02-12) Claim Form Instructions pv05/18/2015. Date. (mm/dd/yyyy) Description of changes. Impact. 02/10/2014. Initial version.
Page 1. PLEASE PRINT OR TYPE. APPROVED OMB-0938-1197 FORM 1500 (02-12)
24 Jan 2018 CMS 1500 (02/12) CLAIM FORM INSTRUCTIONS. FIELD. NUMBE. R. FIELD NAME. INSTRUCTIONS. 1 a. INSURED’S ID NUMBER. Enter the
The current version of the instructions for the 02/12 1500 Claim Form was released in DO NOT email, fax, or mail completed 1500 Claim Forms to the NUCC.
will accept paper claims on only the revised Form 1500, version 02/12. For the The following instructions are required for a Medicare claim. They apply to both
23 Mar 2018 Billing Rules, of the Fee-For-Service Provider Billing Manual and the The revised CMS-1500 health insurance claim form version 02/12
1 Apr 2014 INTRODUCTION. The CMS-1500 health insurance claim form has been revised to the 1500 (02/12) version. In the new version, the 1500
Page 1. APPROVED OMB-0938-1197 FORM 1500 (02-12). PLEASE PRINT OR TYPE. Page 2.Adobe Reader is required to view this page. Go to get.adobe.com/reader/ to download Adobe Reader. Can’t see the PDF? Click here to download it.
APPROVED OMB-0938-1197 FORM 1500 (02-12). PLEASE PRINT OR TYPE NUCC Instruction Manual available at: http://www.nucc.org c. INSURANCE PLAN