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Replace Calculated Field to the Accident Medical Claim Form

Replace Calculated Field to the Accident Medical Claim Form

Aug 6th, 2022

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How to Replace Calculated Field to the Accident Medical Claim Form

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In this video tutorial, the presenter demonstrates how to complete a HICFA 1500 claim form, commonly used by non-institutional healthcare providers to submit claims. The focus is on filling out the form accurately for a secondary claim submission. The presenter starts by selecting "Other" in Box 1 for a commercial insurance policy, then enters the member ID and details in subsequent boxes: Box 2 for the patient's name, Box 3 for the patient's date of birth and gender, Box 5 for the address and phone number, and Box 6 for the patient relationship, which is "self" in this case. The tutorial also notes that different information would be provided if another policyholder was involved. Lastly, it touches on entering the insurance plan name and any additional health benefit plan information if applicable.

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 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 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 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.

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 26 in CMS 1500 claim form?

ID Qualifier - Enter X if billing for emergency services. 26 optional Patients Account Number -Enter the patients medical record number or account number in this field.

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