Update on New 1500 Paper Claim Form (2/12) and NCTracks

The National Uniform Claim Committee (NUCC) published a revised 1500 Paper Claim Form (version 02/12), which replaced version 08/05 earlier this year. The goal of the NUCC in changing the 1500 form was to align the 1500 with changes in the 5010 837P transaction and accommodate ICD-10 reporting needs.

Generally speaking, NCTracks only accepts electronic submission of professional claims, either through the NCTracks Provider Portal or as an 837P X12 transaction. The exceptions are only for time limit overrides and Medicare overrides.

As of September 1, NCTracks will accept the new 1500 paper claim form (2/12), where appropriate. Some of the new 1500 form submission changes are:

- Field 14 (Date of Current Illness, Injury or Pregnancy) now requires a qualifier if a date is submitted. Only qualifier 484 is valid.
- Field 15 (Other Date) also requires a qualifier if a date is submitted. Only qualifier 454 is valid.
- Fields 19 and 30 are not used in NCTracks.
- Field 21 allows up to 12 diagnosis codes, labeled A-L.
- Diagnosis pointers in Field 24E should correspond to the alpha letter of the diagnosis code in Field 21. Numeric pointers are no longer valid.

Note that claims will be rejected in the following circumstances:

1- ICD-10 diagnosis codes submitted prior to ICD-10 effective date
2- 1500 form version 08/05 is submitted after version 02/12 is implemented
3- Provider submits a mix of ICD-9 and ICD-10 diagnoses codes on the same claim.

The change in the 1500 paper claim form does not affect professional claims submitted through the NCTracks Provider Portal or 837 X12 transactions.

The old 1500 form (08/05) will no longer be accepted as of December 1, 2014.