A) The form was been changed to align the paper form with some of the changes in the electronic Health Care Claims: Professional (837), 005010X222 Technical Report Type 3 (5010) and 005010X222A1 Technical Report Type 3 (5010A1).
Q) What is the latest revision?
A) The most recent form is “Revision 02/12.”
Q) What are the specific changes that were made to the form?
A) The most significant changes were the addition of eight diagnosis codes in Item Number 21 and the addition of the QR Code at the top left of the form. no more barcode on the top left, For a complete list of the changes from the current (08/05) version to the revised (02/12), view the Change Log Document (PDF)
[link to http://www.nucc.org/images/stories/PDF/version_0212_1500_change_log.pdf] posted on the NUCC website.
Q) Why was the QR Code added to the top of the form?
A) The QR Code includes a link to an NUCC landing page to provide information about this hcfa form. It also helps align the form for the reader.