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To address if different than field 1. 3a. Patient Control Number Enter your facility's unique account number assigned to the patient, up to 20 alpha/numeric characters. This number will be printed on the RA and will help you identify the patient. 3b. Medical Record Number Number assigned to patient s medical record by provider. Up to 30 alpha/numeric characters. 4. Type of Bill Enter the four digit code that identifies the specific type of bill and frequency of submission. The first dig.

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The UB-04 is the electronic version of CMS-1450 only.

What is an 837 File? An 837 file is an electronic file that contains patient claim information. This file is submitted to an insurance company or to a clearinghouse instead of printing and mailing a paper claim. The data in an 837 file is called a Transaction Set.

Professional Paper Claim Form (CMS-1500)

For paper UB-04 institutional claims, the taxonomy code should be placed in box 81 and submitted with the “B3” qualifier. For paper CMS-1500 claims, the taxonomy code should be identified with the qualifier “ZZ” in the shaded portion of box 24i.

CMS designates the 1500 Health Insurance Claim Form as the CMS-1500 (08/05) and the form is referred to throughout this fact sheet as the CMS-1500. The American National Standards Institute (ANSI) Accredited Standards Committee (ASC) X12N 837P (Professional) Version 5010A1 is the current electronic claim version.

The July 1, 2022, CMS-1500 form implementation is almost here! As you are likely already aware, the Workers' Compensation Board (Board) is transitioning to the CMS-1500 form, which will streamline the medical billing process and reduce the paperwork requirements currently in the workers' compensation system.

Box 23 is used to show the payer assigned number authorizing the service(s).

The MCE checks each diagnosis code, including the admitting diagnosis, and each procedure code against a table of valid ICD-9-CM codes. An admitting diagnosis, a principle diagnosis, and up to eight additional diagnoses may be reported.

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© Copyright 1997-2025
airSlate Legal Forms, Inc.
3720 Flowood Dr, Flowood, Mississippi 39232
Form Packages
Adoption
Bankruptcy
Contractors
Divorce
Home Sales
Employment
Identity Theft
Incorporation
Landlord Tenant
Living Trust
Name Change
Personal Planning
Small Business
Wills & Estates
Packages A-Z
Form Categories
Affidavits
Bankruptcy
Bill of Sale
Corporate - LLC
Divorce
Employment
Identity Theft
Internet Technology
Landlord Tenant
Living Wills
Name Change
Power of Attorney
Real Estate
Small Estates
Wills
All Forms
Forms A-Z
Form Library
Customer Service
Terms of Service
DMCA Policy
About Us
Blog
Affiliates
Contact Us
Privacy Notice
Delete My Account
Site Map
All Forms
Search all Forms
Industries
Forms in Spanish
Localized Forms
Legal Guides
Real Estate Handbook
All Guides
Prepared for You
Notarize
Incorporation services
Our Customers
For Consumers
For Small Business
For Attorneys
Our Sites
US Legal Forms
USLegal
FormsPass
pdfFiller
signNow
airSlate workflows
DocHub
Instapage
Social Media
Call us now toll free:
1-877-389-0141
As seen in:
  • USA Today logo picture
  • CBC News logo picture
  • LA Times logo picture
  • The Washington Post logo picture
  • AP logo picture
  • Forbes logo picture
© Copyright 1997-2025
airSlate Legal Forms, Inc.
3720 Flowood Dr, Flowood, Mississippi 39232