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Replace Name Field to the Accident Medical Claim Form

Replace Name Field to the Accident Medical Claim Form

Aug 6th, 2022

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How to Replace Name Field to the Accident Medical Claim Form

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21 votes

In this video tutorial, the presenter explains how to complete a HICFA 1500 claim form, primarily used by non-institutional healthcare providers to submit claims. While most claims are submitted electronically, secondary claims may need to be sent on paper with the primary Explanation of Benefits (EOB). The example provided is for a patient named Edna. Box 1 is filled with the insurance type, selecting "Other" for a commercial policy, followed by the member ID. Box 2 requires the patient's name, Box 3 the date of birth and gender, Box 5 requires the address and phone number, and Box 6 indicates the patient’s relationship, noted as "self." Additional details include the insurance plan name and checks for other health benefit plans.

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 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.

How many fields are there in the CMS 1500 form?

There are 33 boxes in a CMS-1500 form. All of these boxes must be filled for the insurance claim to pass through. Lets take a look at all the boxes or fields step by step.

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 11 in CMS 1500 claim form?

KEY: R = Required | NR = Not Required | S = Situational, only use if appropriate specific to claim Field IDField DescriptionData Type10dCLAIM CODES (DESIGNATED BY NUCC)S11INSUREDS POLICY GROUP OR FECA NUMBERNR11aINSUREDS DATE OF BIRTH, GENDERNR11bOTHER CLAIM ID (DESIGNATED BY NUCC)NR59 more rows

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 box 9 in CMS 1500?

NOTE: Box 9d on the HCFA / CMS 1500 form is where the Secondary Insurance for a patient populates.

How do I fill out a 1500 claim form?

How to fill out a CMS-1500 form The type of insurance and the insureds ID number. The patients full name. The patients date of birth. The insureds full name, if applicable. The patients address. The patients relationship to the insured, if applicable. The insureds address, if applicable. Field reserved for NUCC use.

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