CMS 1500 Claim Form version 02/12

Effective October 1, 2015, HealthLink will no longer accept the old CMS 1500 Claim Form version 08/05 for paper claims.

Paper claims will only be accepted on the CMS 1500 Claim Form version 02/12.

Any paper claims received on or after October 1, 2015 using the old CMS 1500 Claim Form version 08/05 will be rejected. This applies to claims that may have been submitted prior to the Oct. 1 effective date, but have not been received by HealthLink by the Oct. 1 effective date.

HealthLink began accepting the CMS 1500 Claim Form version 02/12 in January 2014. We suggest that you transition to using the updated CMS 1500 Claim Form version 02/12 now, if you have not already done so.

For information on how to complete the updated 1500 Claim Form version 02/12, follow the guidelines set forth by the National Uniform Claim Committee (NUCC). Please visit the NUCC website at www.nucc.org which provides helpful resources such as a list of changes between the 08/05 and 02/12 claim form versions and the 1500 Instruction Manual.