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Remove Payment Field from the Accident Medical Claim Form

Remove Payment Field from the Accident Medical Claim Form

Aug 6th, 2022

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How to Remove Payment Field from the Accident Medical Claim Form

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In this video tutorial, the presenter demonstrates how to complete a HICFA 1500 claim form, used by non-institutional health care providers to submit claims. While most claims are submitted electronically, secondary claims may require paper submission along with the primary explanation of benefits (EOB). The example highlights a claim for a patient named Edna with commercial insurance. The tutorial outlines filling in key information: Box 1 for insurance type (selecting "other"), Box 2 for the patient’s name, Box 3 for the patient’s date of birth and gender, Box 5 for the patient's address and phone number, and Box 6 for the patient's relationship status. In this case, the relationship is "self," and details are provided for filling in insurance plan information.

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 24D on a CMS 1500 form?

Item 24D - Enter the procedures, services, or supplies using the CMS Healthcare Common Procedure Coding System (HCPCS) code. When applicable, show HCPCS code modifiers with the HCPCS code. The CMS-1500 claim form has the capacity to capture up to four modifiers.

What is the field 9 in CMS 1500 claim form?

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

What information is in Block 24 on the CMS 1500 form?

BLOCK 24 List only one servicing provider on each CMS 1500 claim form. Use a separate line for each service provided. If more than six services were provided for a recipient, a separate claim form for the seventh and any additional services must be completed.

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.

What is field 32 in CMS 1500 claim form?

Item 32 - For services payable under the physician fee schedule and anesthesia services, enter the name and address, and ZIP code of the facility if the services were furnished in a hospital, clinic, laboratory, or facility other than the patients home or physicians office.

What goes in box 24J on the CMS 1500 claim form?

Note: Claims for Physical, Occupational and Speech Therapy billed on a CMS 1500 form should include the rendering providers National Provider ID (NPI). The rendering providers NPI, and taxonomy, if applicable, should be entered in box 24J on the CMS 1500. This will ensure proper processing and payment for services.

What is field 23 in CMS 1500 claim form?

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

What is Box 24 on 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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