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Replace Last Name Field to the Accident Medical Claim Form

Replace Last Name Field to the Accident Medical Claim Form

Aug 6th, 2022

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How to Replace Last Name Field to the Accident Medical Claim Form

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In today’s video, the tutorial covers how to complete a HICFA 1500 claim form, used by non-institutional healthcare providers for submitting claims. Most claims are submitted electronically, but secondary claims may be submitted on paper with the primary Explanation of Benefits (EOB). The example claim is for a patient named Edna, highlighting various boxes on the form: Box 1 is filled with "Other" for a commercial policy; Box 2 includes the patient's name; Box 3 contains the patient’s date of birth and gender; Box 5 is for the address and phone number; Box 6 indicates the patient’s relationship as self. Additional details for other policyholders are also explained, but this example focuses on self-insured 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 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 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 Section 24 in CMS 1500?

What is recorded in Section 24 of CMS-1500? You need to send a claim to a payer who does not accept electronic claims.

What goes in block 24F?

Box 24f is the total billed amount for each service line. Dollar signs and negative amounts should not be entered. Enter 00 in the cents area if the amount is a whole number.

How do I fill out a reimbursement claim form?

How to Fill Care Health Insurance Claim Reimbursement Form Step 1: Fill Out the Details of the Primary Insured. Step 2: Disclose the Insurance History of the Person Filing Claim. Step 3: List Down the Details of the Insured Person Hospitalized. Step 4: Enter the Hospitalization Information.

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 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.

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