Quick Answer: What Goes In Box 17a On CMS 1500?

What goes in box 24j on HCFA 1500?

What is it.

Box 24j Shaded is used to identify the non-NPI if indicated by a qualifier in 24i.

Box 24j displays the NPI of the Rendering Provider..

What does the ZZ qualifier mean?

rendering provider taxonomy codesRENDERING ID QUALIFIER Enter the qualifier indicating what the number reported in the shaded area of 24J represents – 1D or G2 for IHCP LPI rendering provider number, or ZZ or PXC for rendering provider taxonomy codes. (Required, if applicable.) … ZZ and PXC are the qualifiers that apply to the provider taxonomy code.

What qualifier should be listed in block 17 for a referring provider?

Do not submit middle initials or suffixes such as MD, DO, Jr, etc. Also include a valid provider qualifier in the space to the left of the dotted vertical line, before the provider’s name, in block 17.

What information is required on CMS 1500 form?

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.

Why is the CMS 1500 form important?

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 Box 32 on a HCFA?

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. … City, State, and 9-digit ZIP Code.

What goes in box 19 on a CMS 1500?

Box 19 If Applicable Reserved for Local Use – Use this area for procedures that require additional information, justification or an Emergency Certification Statement. This section may be used for an unlisted procedure code when explanation is required and clinical review is required.

Where does the NPI number go on CMS 1500?

Where do I put my NPI number on the CMS 1500? Enter your NPI number in: The non-shaded area of Box 24J. Box 33a.

What are six items needed to reference when completing the CMS 1500?

After the procedure was completed, what are six items needed to reference when completing the CMS-1500 Health Insurance Claim Form?…Patient health record.patient insurance card information.encounter form.insurance claim processing guidelines.patient registration form.precertification information.

What is a CMS 1500 form how is it used for billing?

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.

What is the diagnosis pointer on a CMS 1500?

Diagnosis code pointers are used to indicate the appropriate order of importance in relation to the service being performed. The first pointer designates the primary diagnosis for the service line. Remaining diagnosis pointers indicate declining level of importance to service line. website.

How many boxes are there in CMS 1500 form?

The field has space for 12 codes and the diagnosis code pointers are now identified by letters A-L rather than numbers 1-4. To order CMS 1500 forms and envelopes at a great price go to: http://www.health-forms.com.

What is the proper format for entering a patient’s name on a CMS 1500?

15 Cards in this SetHIPAA privacy standards require providers to notify patients about their right toPrivacyWhich is the proper format for entering the name of the provider in block 33 of the CMS-1500 claim?Howard Hurtz MDWhich is issued by the CMS to individual provider and healthcare institutions?NPI12 more rows

What goes in box 32b on CMS 1500?

What is it? Box 32b is used to indicate the non-NPI identification number of the service facility as assigned by the payer for the facility. Enter the 2-digit qualifier followed by the ID number.