Insert Name Field into the Claims Reporting Form

Aug 6th, 2022
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How to Insert Name Field into 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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9. Name of the INSURED PERSON of other payer in Insurance Information screen under Patient Master.
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.
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.
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
To void a claim, complete the following claim form fields: Field 22: Include the most appropriate void reason code from the table. In the Original Reference Number area, enter the last paid Internal Control Number (ICN) of the claim. Medicaid Resubmission Code ORIGINAL REF.
Box 23 is used to show the payer assigned number authorizing the service(s).
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.
KEY: R = Required | NR = Not Required | S = Situational, only use if appropriate specific to claim Field IDField DescriptionData Type21DIAGNOSIS OR NATURE OF ILLNESS OR INJURYR22RESUBMISSIONNR23PRIOR AUTHORIZATION NUMBERNR24SHADED AREA SUPPLEMENTAL INFORMATION59 more rows

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