Easily Hide Name Field in the Accident Medical Claim Form

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How to Hide Name Field in the Accident Medical Claim Form

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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 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 required in box 32 of CMS 1500?

32 Required Service Facility Location Information - Enter the provider name. Enter the provider address, without a comma between the city and state, and a nine-digit zip code, without a hyphen. Enter the telephone number of the facility where services were rendered, if other than home or office.

What goes in box 4 on a CMS 1500?

This is a required field. Item 3 - Enter the patients 8-digit birth date (MM | DD | CCYY) and sex. Item 4 - If there is insurance primary to Medicare, either through the patients or spouses employment or any other source, list the name of the insured here.

What block on the medical claim form do you enter the patients last name first name and middle initial?

Block 2 PATIENTS NAME (Last Name, First Name, Middle Initial) Enter the patients (recipients) name as it appearBlock 24C EMG Leave Blank. Block 3 PATIENTS BIRTH DATE/SEX Enter the patients (recipients) date of birth and sex.

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 is field 23 in CMS 1500 claim form?

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

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.

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Hide Name Field in the Accident Medical Claim Form