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CMS 1500 (08 05) Description Field

CMS 1500 (08 05) Description Field-2025

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The document provides detailed guidelines for submitting claims using the CMS 1500 and UB04 forms in compliance with HIPAA v5010 standards. It outlines specific data values required for various fields, including provider identifiers (NPI and UMPI), service facility locations, and billing information. The document emphasizes the importance of accurate reporting of provider details, especially when different providers are involved in patient care, and directs users to additional resources for further instructions.

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Click ‘Get Form’ to open the CMS 1500 (08/05) in our editor.
Locate Box 24I and 24J, which are designated for the Rendering Provider ID. Enter the appropriate identifiers as required.
In Box 32a, input the Service Facility Location NPI. Ensure this is accurate to avoid claim rejections.
For Billing Provider Info, fill in Box 33a with the NPI and Box 33b with UMPI as necessary.
Review all entries for accuracy before submitting your claim. Utilize our platform's features to save and export your completed form easily.

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Versions	Form popularity	Fillable & printable
2014	4.8 Satisfied (120 Votes)
2011	4.4 Satisfied (159 Votes)

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What is entered in block 17b of the CMS 1500 claim?

Item 17b - Enter the NPI of the referring, ordering, or supervising physician or non- physician practitioner listed in item 17. All physicians and non-physician practitioners who order services or refer Medicare beneficiaries must report this data.

What is CMS 1500 with description?

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 field 23 in the CMS 1500 claim form?

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 is field 27 in the CMS 1500 claim form?

What is it? Box 27 is used to indicate that the provider agrees to accept assignment under the terms of the payers program.

What is field 22 in 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 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 does box 27 on CMS 1500 mean?

Item 27 on the CMS-1500 claim form allows the provider to indicate whether they accept or do not accept assignment. When accepting assignment, the beneficiary may be billed for the 20% coinsurance, any unmet deductible and for services not covered by Medicare.

CMS 1500 (08 05) Description Field-2025

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What is entered in block 17b of the CMS 1500 claim?

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CMS 1500 (08 05) Description Field-2025

Here's how it works

How to use or fill out CMS 1500 (08 05) Description Field with DocHub

See more CMS 1500 (08 05) Description Field versions

Complete this form in 5 minutes or less

Got questions?

What is entered in block 17b of the CMS 1500 claim?

What is CMS 1500 with description?

What is field 23 in the CMS 1500 claim form?

What is field 27 in the CMS 1500 claim form?

What is field 22 in CMS 1500 claim form?

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What are the fields in the CMS 1500 form?

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