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What are all the changes in New HCFA 1500 from older version?

Below are the list changes from old version 08/05 HCFA 1500 to New Version 02/12 HCFA form.

Location
Change
Header

Replaced 1500 rectangular symbol with black and white two-dimensional QR Code (Quick Response Code).

Header

Added "(NUCC)" after "APPROVED BY NATIONAL UNIFORM CLAIM COMMITTEE."

Header

Replaced "08/05" with "02/12."

Item Number 1

Changed "TRICARE CHAMPUS" to "TRICARE" and changed "(Sponsor’s SSN)" to "(ID#/DoD#)."

Item Number 1

Changed "(SSN or ID)" to "(ID#) under "GROUP HEALTH PLAN."

Item Number 1

Changed "(SSN)" to "(ID#)" under "FECA BLK LUNG."

Item Number 1

Changed "(ID)" to "(ID#)" under "OTHER."

Item Number 8

Deleted "PATIENT STATUS" and content of field. Changed title to "RESERVED FOR NUCC USE."

Item Number 9b

Deleted "OTHER INSURED’S DATE OF BIRTH, SEX." Changed title to "RESERVED FOR NUCC USE."

Item Number 9c

Deleted "EMPLOYER’S NAME OR SCHOOL." Changed title to "RESERVED FOR NUCC USE."

Item Number 10d

Changed title from "RESERVED FOR LOCAL USE" to "CLAIM CODES (Designated by NUCC)."

Item Number 11b

Deleted "EMPLOYER’S NAME OR SCHOOL." Changed title to "OTHER CLAIM ID (Designated by NUCC)." Added dotted line in the left-hand side of the field to accommodate a 2-byte qualifier.

Item Number 11d

Changed "If yes, return to and complete Item 9 a-d" to "If yes, complete items 9, 9a, and 9d."

Item Number 14

Changed title to "DATE OF CURRENT ILLNESS, INJURY, or PREGNANCY (LMP)." Removed the arrow and text in the right-hand side of the field. Added "QUAL." with a dotted line to accommodate a 3-byte qualifier.


2 of 2

Location Change
Item Number 15 Changed title from "IF PATIENT HAS HAD SAME OR SIMILAR ILLNESS. GIVE FIRST DATE" to "OTHER DATE." Added "QUAL." with two dotted lines to accommodate a 3-byte qualifier.
Item Number 17 Added a dotted line in the left-hand side of the field to accommodate a 2-byte qualifier.
Item Number 19 Changed title from "RESERVED FOR LOCAL USE" to "ADDITIONAL CLAIM INFORMATION (Designated by NUCC)."
Item Number 21 Changed instruction after title from "(Relate Items 1, 2, 3 or 4 to Item 24E by Line)" to "Relate A-L to service line below (24E)."
Item Number 21 Removed arrow pointing to 24E.
Item Number 21 Added "ICD Ind." and two dotted lines in the upper right-hand corner of the field to accommodate a 1-byte indicator.
Item Number 21 Added 8 additional lines for diagnosis codes. Evenly spaced the diagnosis code lines within the field.
Item Number 21 Changed labels of the diagnosis code lines to alpha characters (A – L).
Item Number 21 Removed the period within the diagnosis code lines.
Item Number 22 Changed title from "MEDICAID RESUBMISSION" to "RESUBMISSION."
Item Number 30 Deleted "BALANCE DUE." Changed title to "Rsvd for NUCC Use."
Footer Changed "APPROVED OMB-0938-0999 FORM CMS-1500 (08/05)" to "APPROVED OMB-0938-1197 FORM 1500 (02/12)."
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