Insert Option Field into the Claims Reporting Form

Aug 6th, 2022
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A step-by-step instructions on the way to Insert Option Field into the Claims Reporting Form

  1. Drag and drop your document to your Dashboard or upload it from cloud storage app.
  2. Use DocHub advanced PDF editing features to Insert Option Field into the Claims Reporting Form.
  3. Change your document and make more adjustments if required.
  4. Add more fillable fields and designate them to a specific recipient.
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How to Insert Option Field into the Claims Reporting Form

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Hi everyone, Kevin here. Today I want to show you how you can create your very own fillable form using Microsoft Word. First off, what is a fillable form? You can have people go in and fill out a form, but they wont be able to edit the questions or the structure of the form. You can use things like check boxes, text fields, drop down lists, date pickers, to build your form. Once someones finished completing your form, they can e-mail it back, they could print it out, or you could even connect it to a database. Connecting to a database is outside of the scope of todays tutorial. Its kind of like an docHub PDF form, but its Microsofts version of it. Ive included sample files today if you want to follow along, otherwise lets jump on the PC and lets get started. Here I am in Microsoft Word and to be able to do this first you need a Word document that you want to transform into a form. Here I have an order form for the Kevin Cookie Company. To follow along, once

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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
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.
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
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.
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.
When you find the field you want to add, do one of the following to add it to the form or report: Double-click the field. Drag the field from the Field List pane to the form or report. Hold the CTRL key and click several fields, and then drag them all to the form or report at the same time.
Box 23 is used to show the payer assigned number authorizing the service(s).

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