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Delete Payment Field to the Accident Medical Claim Form

Delete Payment Field to the Accident Medical Claim Form

Aug 6th, 2022

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How to Delete Payment Field to the Accident Medical Claim Form

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In today's video, the tutorial covers how to complete a HICFA 1500 claim form, used by non-institutional health care providers to submit claims. While most claims are submitted electronically, secondary claims may require paper submission with the primary Explanation of Benefits (EOB). The example claim is for a patient named Edna, with the insurance type indicated as "Other" for a commercial policy. Key boxes are filled out, including Box 1 for insurance type, Box 2 for the patient's name, Box 3 for their date of birth and gender, Box 5 for the address and phone number, and Box 6 for the patient's relationship (self). If applicable, information for a different guarantor would be included instead. The tutorial also prompts for the insurance plan name and queries about other health benefit plans.

Got questions?

Below are some common questions from our customers that may provide you with the answer you're looking for. If you can't find an answer to your question, please don't hesitate to reach out to us.

What fields are on a CMS 1500 form?

Field by Field Explanation Of The CMS-1500 Form a. PATIENT NAME from Patient Master. Patient DOB and SEX from Patient Master. Name of the INSURED PERSON of the destination payer in Insurance Information screen under Patient Master. PATIENT ADDRESS, CITY, STATE, ZIP CODE HOME PHONE from Patient Master.

What is field 24 in CMS 1500 claim form?

A Place of Service (POS) is a field used when completing a CMS 1500 form to submit a claim to insurance. It indicates the location in which the health care service is actually provided.

What is field 22 in CMS 1500 claim form?

Complete box 22 (Resubmission Code) to include a 7 (the Replace billing code) to notify us of a corrected or replacement claim, or insert an 8 (the Void billing code) to let us know you are voiding a previously submitted claim. Enter the Blue Cross NC original claim number as the Original Ref.

What goes in box 23 on the CMS 1500 form?

Box 23 - TITLE: Prior Authorization Number (this field is also used for CLIA numbers) INSTRUCTIONS: Enter any of the following: prior authorization number, referral number, or Clinical Laboratory Improvement Amendments (CLIA) number, as assigned by the payer for the current service.

What is the field 9 in CMS 1500 claim form?

9. Name of the INSURED PERSON of other payer in Insurance Information screen under Patient Master.

What is field 23 in cms 1500 claim form?

Box 23 is used to show the payer assigned number authorizing the service(s).

What is field 11 in cms 1500?

KEY: R = Required | NR = Not Required | S = Situational, only use if appropriate specific to claim Field IDField DescriptionData Type10cS10dCLAIM CODES (DESIGNATED BY NUCC)S11INSUREDS POLICY GROUP OR FECA NUMBERNR11aINSUREDS DATE OF BIRTH, GENDERNR59 more rows

What is field 24 in cms 1500 claim form?

A Place of Service (POS) is a field used when completing a CMS 1500 form to submit a claim to insurance. It indicates the location in which the health care service is actually provided.

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