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Box 23 - TITLE: Prior Authorization Number (this field is also used for CLIA numbers) INSTRUCTIONS: Enter any of the following: prior authorization number, referral number, or Clinical Laboratory Improvement Amendments (CLIA) number, as assigned by the payer for the current service.
What goes in box 33 on a claim?
Whats in the box? This box contains the Billing Providers name, address, and phone number. This information lets the Insurance company know where to direct payment. Note that the Billing Provider can be an individual or a group/organization.
What comes in box 4 in cms 1500 claim form?
Box 4 (if applicable): Insureds name is required to be entered here. It wont be required unless you are billing for an infant using the mothers ID. Box 7: This field requires you to enter the insureds address. The street address, area, state, ZIP code, and telephone number are included.
What is box 33 in cms 1500?
Box 33 is used to indicate the name and address of the Billing Provider that is requesting to be paid for the services rendered.
What is field 9 in cms 1500 claim form?
9. Name of the INSURED PERSON of other payer in Insurance Information screen under Patient Master.
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Box 13 is the authorization of payment of medical benefits to the provider of service. If this box is completed, the patient is indicating that they want any payments for the services being billed to be sent directly to the provider.
What goes in box 23 on a CMS 1500?
Box 23 - TITLE: Prior Authorization Number (this field is also used for CLIA numbers) INSTRUCTIONS: Enter any of the following: prior authorization number, referral number, or Clinical Laboratory Improvement Amendments (CLIA) number, as assigned by the payer for the current service.
What goes in box 33 on a CMS 1500?
33 Required Billing Provider Info Phone # (Pay-To) - Enter the provider name. Enter the provider address, without a comma between the city and state, and a nine-digit zip code, without a hyphen. Enter the telephone number. 33a Required Billing Provider Info Phone # (Pay-To, NPI) - Enter the billing providers NPI.
Related links
Swing Bed Minimum Data Set Assessment Training Manual
30-Oct-2003 Swing Bed Minimum Data Set Assessment Form (SB-MDS) to the CMS SB-MDS intranet through this network. Minimum Data. Set. MDS. A core set of
Non-Physician Medical Practitioners (NMP) Billing Example
This section is to assist providers in completing the CMS-1500 claim when a Non-Physician Enter code X6954 with modifier SB (indicating the service was.
Molina Healthcare Non-Participating Guide for Providers
Non-electronic claims must be submitted to Molina on a CMS 1500 or UB-04 claim form that is legible and accurate within ninety-five (95) days of the date of
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