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ADDITIONAL CMS-1500 CLAIM FORM AND NPI INSTRUCTIONS
Get ADDITIONAL CMS-1500 CLAIM FORM AND NPI INSTRUCTIONS
Viders who order services or refer Medicare beneficiaries must report this data. 24J Rendering Provider s NPI Item 24J Enter the rendering provider s NPI number in the lower unshaded portion. Note: This does not apply to influenza virus and pneumococcal vaccine claims submitted on roster bills as they do not require a rendering provider NPI. 32a Facility NPI Number Item 32a - Enter the NPI of the service facility location where the services were provided. 33a Billing Provider NPI.
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Medicare FAQ
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.
Note: Claims for Physical, Occupational and Speech Therapy billed on a CMS 1500 form should include the rendering provider's National Provider ID (NPI). The rendering provider's NPI, and taxonomy, if applicable, should be entered in box 24J on the CMS 1500. This will ensure proper processing and payment for services.
Box 32 is used to indicate the name and address of the facility where services were rendered. Enter the name, address, city, state, and ZIP code of the location. Enter the name and address information in the following format: Name.
How to fill out a CMS-1500 form The type of insurance and the insured's ID number. The patient's full name. The patient's date of birth. The insured's full name, if applicable. The patient's address. The patient's relationship to the insured, if applicable. The insured's address, if applicable. Field reserved for NUCC use.
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.
Learn how to submit a CMS 1500 to a secondary payor. Aug 2, 2021•Knowledge Navigate to the $ Billing module and select Billing. Click on the dashed line underlining the Payor and select the secondary insurance the claim is being submitted to under the drop-down menu. Click on the red checkmark to save.
Item 17a - Enter the CMS assigned UPIN (the NPI will be used when implemented) of the referring/ordering physician listed in item 17. When a claim involves multiple referring and/or ordering physicians, a separate Form CMS-1500 must be used for each ordering/referring physician.
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 provider's NPI.
Supervising Related content
Medicare Claims Processing Manual, Chapter 26
Dec 11, 2009 — Providers sending professional and supplier claims to Medicare on paper...
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