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Insert Payment Field to the Claims Reporting Form

Insert Payment Field to the Claims Reporting Form

Aug 6th, 2022

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How to Insert Payment Field to the Claims Reporting Form

4.6 out of 5

51 votes

previous video we had a look at how to create a form where you could update the fields using advanced custom fields and in this case a repeater which then updates the product options and then totals the product price with the product options and that would then be included in an email but no payment was part of that transaction so in this video well have a look to see how we can add the transact transaction site to that so now if we go to the next page youll see that here we have two payment methods listed we have the payment amount and we have the item which is listed here and ill show you how we set all this up and then we have an additional space for a message so if the person was to make this transaction and were just going to go with the offline payment and we had a message in there and we submit the form youll see that what they would receive then is an email that weve set up which has the main product which is thats the product name and the price then we had the additiona

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Got questions?

Below are some common questions from our customers that may provide you with the answer you're looking for. If you can't find an answer to your question, please don't hesitate to reach out to us.

What is field 23 in CMS 1500 claim form?

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

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 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?

Box 4 INSUREDS NAME If the patient is a dependent OR a secondary claim form is being printed AND other than self is the insured, then the name of the insured prints from the Registration --►Regular --►Patient Insurance screen , , fields.

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