Easily Insert Name Field from the Claims Reporting Form

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How to Insert Name Field from the Claims Reporting Form

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[Music] hey guys so we are going to learn now about how to use form elements in Microsoft Word the first thing that you need to do is make sure that you have your Developer tab enabled if you do not see this Developer tab let me show you how to enable it okay so anywhere in your ribbon where theres a bit of space you can right click and say customize of the ribbon customize the ribbon and if you look on the right-hand side youll see all the various tabs that we have available developer will be one of those tabs you will probably see it like that where it will not have a tick next to it just put a tick next to it to developer and click OK alright so right click the ribbon and customize the ribbon okay if you forget about right-clicking the ribbon just go file and options and customize ribbon there it is there file options customize a ribbon or just right click ok so lets have a look at what we going to do here were going to use for this first part of the video we can use whats call

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What codes are used on a 1500 claim form?

Other CMS-1500 Codes Box 11b - Other Claim ID. Box 14 - Date of Current Illness, Injury, or Pregnancy (LMP) Box 15 - Other Date. Box 17 - Name of Referring Provider or Other Source. Box 17a, 19, 24i, 32b, 33b - Identifier Qualifiers. Box 21 - ICD indicator. Box 22 - Bill Frequency Code. Box 24h - EPSDT Reason Codes.

What goes in box 9 on a CMS 1500 claim form?

NOTE: Box 9d on the HCFA / CMS 1500 form is where the Secondary Insurance for a patient populates.

What is field 23 in CMS 1500 claim form?

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

How to fill out a CMS 1500 claim form?

How to fill out a CMS-1500 form The type of insurance and the insureds ID number. The patients full name. The patients date of birth. The insureds full name, if applicable. The patients address. The patients relationship to the insured, if applicable. The insureds address, if applicable. Field reserved for NUCC use.

What is field 9 in CMS 1500 claim form?

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

What fields are on a CMS 1500 form?

1500 Claim Form Required Fields 1500 Required Fields Number and NameExample1a. Insureds ID #1234567892. Patients NamePatient, Mary R.3. Patients DOB Patients SEX01012000 M or F4. Insureds NamePatient, Joe18 more rows

What goes in box 17a on CMS 1500?

Box 17a. The Other ID number of the referring, ordering, or supervising provider is reported in 17a in the shaded area. The qualifier indicating what the number represents is reported in the qualifier field to the immediate right of 17a.

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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