Easily Insert Surname Field into the Insurance Plan

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How to Insert Surname Field into the Insurance Plan

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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.

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What is entered in Block 1 on the CMS 1500 claim form?

BLOCK 1A INSUREDS ID NO. ( The recipient identification number is the nine-digit number found on the South Dakota Medicaid Identification Card. The three-digit generation number that follows the nine-digit recipient number is not part of the recipients ID number and should not be entered on the claim.

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 Block 14 on CMS 1500 form?

Box 14 - Date of Current Illness, Injury, or Pregnancy (LMP) Enter the applicable qualifier to identify which date is being reported.

What is Block 9 on CMS 1500 form for?

The recipients name must match the name on the recipients Medicaid ID and the online portal. BLOCK 9 OTHER INSUREDS NAME Leave blank. If there is other insurance refer to CMS 1500 Third-Party Liability Claim or Medicare Crossover Claim instructions.

What goes on box 24c on CMS 1500?

Box 24c. EMG indicator (also called emergency indicator) is a carryover from the older CMS-1500 form and is unlikely to be required on current claims. If needed, however, you can add the EMG field via the service line Column Chooser.

What block on the Medicaid claim form do you enter the patients last name first name and middle initial?

Block 4 INSUREDS NAME (Last Name, First Name, Middle Initial) Enter the name of the person in whose name the third party coverage is listed, only when applicable. Optional. Block 5 PATIENTS ADDRESS Enter the patients (recipients) complete mailing address with zip code and telephone number.

What information goes into Block 9 of a CMS claim form?

Box 9 indicates that there is another policy that may cover the patient. The insureds name is entered as Last Name, First Name, Middle Initial, separated by commas.

What information goes into Block 11 of a CMS claim form?

item 11. Enter the employers name, if applicable. If there is a change in the insureds insurance status, e.g., retired, enter either a 6-digit (MM | DD | YY) or 8-digit (MM | DD | CCYY) retirement date preceded by the word RETIRED.

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Insert Surname Field into the Insurance Plan