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  • Cms-1500 Field Descriptions 2012

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How to fill out the CMS-1500 Field Descriptions online

This guide provides comprehensive instructions on completing the CMS-1500 form fields efficiently and accurately. Whether you are new to digital document management or seeking clarification, follow these steps for a smooth experience.

Follow the steps to complete the CMS-1500 form accurately.

  1. Press the ‘Get Form’ button to access the CMS-1500 form online and open it for editing.
  2. Locate Field FL 1a, which is for the insured's ID number. Enter the 8-digit member ID assigned by the payer.
  3. Proceed to Field FL 2 for the patient's name. Enter the last name, first name, and middle initial of the patient.
  4. In Field FL 3, input the patient's birth date in MM/DD/YYYY format and indicate the sex using 'M' for male or 'F' for female.
  5. If the insured's name differs from the patient's, complete Field FL 4 with the insured's name details.
  6. In Field FL 5, provide the patient's full mailing address, including street, city, state, and ZIP code.
  7. Field FL 9 requires the name of any other insured individual if applicable. Fill in details such as the last name and first name.
  8. Complete Field FL 10 by indicating the patient's condition related to employment, auto accident, or another accident with a simple 'yes' or 'no.'
  9. For Field FL 11, provide the insured's policy or group number if applicable.
  10. In Field FL 21, enter the diagnosis or nature of illness with the highest specificity using the appropriate codes.
  11. Fill in the total charge for services in Field FL 28.
  12. Review all entries for accuracy, then save your changes. You can download, print, or share the completed form as needed.

Start filling out your CMS-1500 form online today for efficient processing.

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The DN in box 17 of the CMS-1500 form indicates that the rendering provider is the same as the referring provider. This code streamlines the information for insurers, clarifying the relationship between the providers. Properly using DN can help avoid misunderstandings in the billing process. Consult the CMS-1500 Field Descriptions for more information on this code.

Box 32B of the CMS-1500 form is for the facility's NPI when services are rendered in a facility setting. This information allows claims to be associated correctly with the right facility, promoting smooth processing. Accurate completion of this box helps in ensuring your claims are handled without delays. Refer to the CMS-1500 Field Descriptions for complete instructions.

The rendering provider is the individual who actually performed the service, while the supervising provider oversees that service. This distinction is vital in practices involving multiple providers, as it defines accountability and roles. Knowing how to input this information accurately is essential for compliance and payment processing. Review the CMS-1500 Field Descriptions for clarity on these roles.

Block 17 on the CMS-1500 form is designated for the referring provider's name and NPI. This block is crucial for claims where a patient was referred for certain services. Correctly filling out this section prevents delays in payment and helps clarify the provider network. Explore the CMS-1500 Field Descriptions for precise guidance on filling out block 17.

The CMS-1500 form consists of several boxes, each designed for specific information about the patient and services rendered. These include boxes for patient demographics, insurance details, and type of services provided. Understanding these boxes enhances your ability to complete the form accurately. Refer to the CMS-1500 Field Descriptions for a comprehensive guide on what each box entails.

Field 25 on the CMS 1500 claim form is designated for reporting the federal tax identification number of the healthcare provider. This field is critical for verifying the provider's identity and tax status. Knowing this detail through CMS-1500 field descriptions helps to ensure compliance with billing requirements, promoting timely payments.

A standard claim form like the CMS 1500 contains five major sections: patient information, provider information, insurance information, service details, and the corresponding diagnosis. Each section prompts specific data entries that are vital for proper claim processing. Understanding these sections through the CMS-1500 field descriptions enhances the chances of a smooth reimbursement cycle.

Field 11 of the CMS 1500 claim form is where you provide the patient's insurance plan information. This field includes options for multiple insurance plans if applicable. By accurately reporting this information, as outlined in the CMS-1500 field descriptions, you enhance the accuracy and efficiency of the claims submission.

Field 23 on the CMS 1500 form asks for the prior authorization number if required by the insurance provider. This number serves as proof of approval for the services rendered. Understanding this aspect of the CMS-1500 field descriptions can help streamline the claims process, ensuring that you receive prompt payment.

Field 32 on the CMS 1500 claim form is where you enter the service facility's name and address if it differs from the provider's address. This field is crucial for claims related to specific service locations. By accurately filling out this field as part of the CMS-1500 field descriptions, you help ensure that claims are directed to the right location.

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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
Privacy Notice
Legal Hub
Content Takedown Policy
Bug Bounty Program
About Us
Blog
Affiliates
Contact Us
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 WorkFlow
DocHub
Instapage
Social Media
Call us now toll free:
+1 833 426 79 33
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