Easily Hide Date Field from the Accident Medical Claim Form

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How to Hide Date Field from the Accident Medical Claim Form

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What is field 17 on a claim form?

Information about Item 17 (Name of Referring Provider or Other Source) Item 17 of the CMS-1500 (02-12) claim form is reserved for the Referring Provider or Other Source. ing to the. National Uniform Claim Committee, NUCC, if multiple providers are involved, enter one provider in the following.

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 32 in CMS 1500 claim form?

Item 32 - For services payable under the physician fee schedule and anesthesia services, enter the name and address, and ZIP code of the facility if the services were furnished in a hospital, clinic, laboratory, or facility other than the patients home or physicians office.

What is field 17 in CMS 1500 claim form?

Box 17 - Name of Referring Provider or Other Source Enter the applicable qualifier to identify which provider is being reported. Enter the qualifier to the left of the vertical, dotted line.

What is field 26 in CMS 1500 claim form?

ID Qualifier - Enter X if billing for emergency services. 26 optional Patients Account Number -Enter the patients medical record number or account number in this field.

What is 32a on HCFA form?

Box 32a is used to indicate National Provider Identifier number of the Service Facility. Only report a Service Facility NPI when the NPI is different from the Billing Provider NPI.

Is Box 32 on CMS 1500 required?

If a Provider does not have a group NPI number, the national standard for EDI claims is that Box 32 is not necessary as it is already displayed in Box 33. Normally for claims standards, there are two sets of rules; one that applies to printed HCFA claims and a second set of standards that apply to EDI claims.

What is field 33 in CMS 1500 claim form?

What does the billing box 33 mean on the CMS 1500 form? Box 33 of the CMS 1500 form derives from the selected employeess Claims Settings area in the contact. Provide the billing providers name, address, NPI, EIN, and the phone number.

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