Page 1. APPROVED OMB-0938-11 (02-12). PLEASE PRINT OR TYPE. Medi-Cal will begin accepting the new 02/12 version of the CMS-1500 on. January 6, switch software for mach3 cnc 2014. Both the new and old claim forms will be accepted until. March 31. Home - Opens in a new window. Form CMS 1500; Form Title: Health. Insurance Claim Form; Revision Date:. CMS Manual: N/A; Special. Instructions: Starting April 1, 2014 only the revised, 02-12. CMS-1500 PDF, 3MB. BECAUSE THIS FORM IS USED BY VARIOUS GOVERNMENT AND PRIVATE. HEALTH PROGRAMS, SEE SEPARATE INSTRUCTIONS ISSUED BY. Jan 6, 2014. New CMS-1500 Form Effective April 1, 2014. Winter. CMS-1500 form which is used by clinical. form_instruction_manual_2012_02.pdf. Fill cms form denise instantly, download blank or editable online. Sign, fax and printable from PC, iPad, tablet or mobile. No software. Try. Now! Mar 13, 2014. April 1 deadline to begin using new CMS 1500 claim form. should not begin using ICD-10-CM codes until Oct. 1, 2014 (PDF, 552KB). Mar 18, 2014. CORRECTION : Revised CMS-1500 form Effective April 1, 2014. From:. The new form will help providers transition to ICD-10 because of the addition of. cc. org/images/stories/PDF/1500_claim_form_2012_02.pdf. Sep 17, 2013. The 1500 claim form (AKA HCFA 1500 or. Reviewed existing data and needs for new. January 6, 2014: Payers begin receiving and).