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  • Approved Omb - 0938 -0999 Form Cms-1500 ( 08 -05)...

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CARRIER 1500 HEALTH INSURANCE CLAIM FORM APPROVED BY NATIONAL UNIFORM CLAIM COMMITTEE 08/05 PICA PICA MEDICARE MEDICAID (Medicare #) TRICARE CHAMPUS (Sponsor s SSN) (Medicaid #) GROUP HEALTH PLAN.

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Form CMS-1500 is the standard paper claim form used to bill an insurance for rendered services and supplies. It provides information about the client, their corresponding insurance policy, and their diagnosis and treatment.

Enter the patient's mailing address and telephone number. On the first line enter the street address; the second line, the city and state; the third line, the ZIP code and Page 2 Instructions on how to fill out the CMS 1500 Form telephone number. If Medicare is primary, leave blank.

PICA AlignmentPICA is located on the top left of the CMS-1500 form. PICA is the alignment blocks, and the horizontal line at the base of the alignment boxes used to facilitate the image processing technology of OCR equipment.

What is it? Box 17a is the non-NPI ID of the referring provider and is a unique identifier or a taxonomy code. The qualifier indicating what the number represents is reported in the qualifier field to the immediate right of 17a.

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© Copyright 1997-2025
airSlate Legal Forms, Inc.
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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
Content Takedown Policy
About Us
Blog
Affiliates
Contact Us
Privacy Notice
Delete My Account
Site Map
Industries
Forms in Spanish
Localized Forms
State-specific Forms
Forms Kit
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