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What goes in box 19 on a CMS 1500?

Box 19 is used to identify additional information about the patients condition or the claim. See the NUCC 1500 Health Insurance Claim Form Reference Instruction Manual for additional details.

What goes in box 15 on a CMS 1500 form?

Information about Item 15 (Other Date) The National Uniform Claim Committee (NUCC) claim form specification state to use Item 15 to identify additional date information about the patients condition. Report the information that is required by the payer receiving claims.

What goes in box 33B on CMS 1500?

Box 33B: By default, this box will remain blank; however, if a particular payer wants to see a separate provider ID number in that box, you can add it, by the provider, for that particular payer.

What is field line in CMS 1500 claim form?

1500 Claim Form Required Fields 1500 Required Fields Number and NameExample1a. Insureds ID #1234567892. Patients NamePatient, Mary R.3. Patients DOB Patients SEX01012000 M or F4. Insureds NamePatient, Joe18 more rows

What goes in box 17a on CMS 1500?

Box 17a. The Other ID number of the referring, ordering, or supervising provider is reported in 17a in the shaded area. The qualifier indicating what the number represents is reported in the qualifier field to the immediate right of 17a.

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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.

What goes in box 32a on CMS 1500?

32a Required Service Facility Location Information - Enter the NPI of the facility where the services were rendered. 32b If Applicable Service Facility Location Information -Enter the Medi-Cal provider number for an atypical service facility.

What is field 33 in CMS 1500 claim form?

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.

What is the taxonomy code 33B?

Typically, a claim will need to reflect the taxonomy code associated with your billing provider NPI in box 33b, which may either be an individual or organizational NPI. Certain payers may also require the taxonomy code associated with your rendering provider NPI in box 24j, which would be your individual NPI.

What is box 16 in CMS 1500?

Box 16 identifies the time span the patient is, or was, unable to work if they are employed and unable to work in their current occupation. This can be entered using the 6-digit (MMDDYY) or 8-digit (MMDDYYYY) date format. An entry in this field may indicate employment-related insurance coverage.

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