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What is field 22 in the CMS 1500 claim form?

This is also known as the Claim Reference Number or ICN. If this is not filled out, the insurer will not be able to reference the original claim when processed your request. On the CMS 1500 claim when updated, the resubmission code and original reference number will populate into Box 22.

What is field 23 in 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 type of claims are submitted on a CMS 1500?

The CMS-1500 form is the standard claim form used by a non-institutional provider or supplier to bill Medicare carriers and durable medical equipment regional carriers (DMERCs) when a provider qualifies for a waiver from the Administrative Simplification Compliance Act (ASCA) requirement for electronic submission of

What is Box 33 on CMS 1500 claims?

On the CMS 1500 claim form, the billing provider name, address, and phone number from Healthie will populate in Box 33. You can add the Type 2/NPI 2 or Organizational NPI that appears in Box 33 by going to Organization Settings.

What loop is box 23?

Once entered and a lab test is entered into a patients claim, the CLIA number will appear in box 23 on the paper HCFA and in loop 2300 (claim information) and/or loop 2400 (service line information) for electronic claims.

1500 health insurance claim form 2012

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What are the fields in the CMS 1500 form?

1500 Claim Form Required Fields 1500 Required Fields Number and NameExample 1a. Insureds ID # 123456789 2. Patients Name Patient, Mary R. 3. Patients DOB Patients SEX 01012000 M or F 4. Insureds Name Patient, Joe18 more rows

What is the National Uniform Claim Committee (NUCC) and what are they responsible for?

The NUCC was formally named in the administrative simplification section of the HIPAA of 1996 as one of the organizations to be consulted by the American National Standards Institutes accredited SDOs and the Secretary of HHS as they develop, adopt, or modify national standards for health care transactions.

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