Easily Insert Mandatory Field into the Accident Medical Claim Form

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How to Insert Mandatory Field into the Accident Medical Claim Form

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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 goes in box 26 on CMS 1500?

This number will be transmitted to the payer with each submitted claim. On the HCFA-1500 form, it will print in box 26 under the label Patients Account No.. The first 6 digits will be your client group account number with DrChrono and the following 9 digits are the patients claim id/account number.

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 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 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 the modifier 26 for Medicare claims processing manual?

Modifier 26 is appended to billed codes to indicate that only the professional component of a service/procedure has been provided. It is generally billed by a physician. Services with a value of 1 or 6 in the PC/TC Indicator field of the National Physician Fee Schedule may be billed with modifier 26.

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 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.

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Insert Mandatory Field into the Accident Medical Claim Form