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Items 14 - 33 — This document is published in cooperation with the National Uniform Claim Committee (NUCC) by the. American Medical Association (AMA). Permission The 1500 claim form is developed and maintained by the NUCC. • The form is in the public domain. • The form is used by federal payer programs, e.g.,. The following is the PDF of the revised 1500 form, including the template and grid versions: (The form image may not print to scale. This image of the form Items 14 - 33 — This NUCC Reference Instruction Manual provides specific instructions on how to complete the 1500. Claim Form. Instructions and information The NUCC Data Set was previously released in 2003. It was revised in January 2009 to accommodate the changes to the 08/05 version of the 1500 Claim Form. Users HEALTH INSURANCE CLAIM FORM NUCC Instruction Manual available at: nucc.org. PLEASE PRINT OR TYPE. APPROVED OMB-0938-1197 FORM 1500 (02-12). to the NUCC 1500 Claim Form. Reference Instruction Manual. With instructions for billing the 1500 version 02/12 form. An Independent Licensee of the Blue Items 14 - 33 — The NUCC has developed this general instructions document for completing the 1500 Claim Form. This document is.