Friday 24 August 2012

completing CMS 1500 instruction - Field 1 - 13


Tips for Completing the CMS-1500 Claim Form

Member Information (Fields 1-13)

Field Number : 1
Field Description : Coverage
Data Type : Optional
Instructions : Show the type of health insurance coverage applicable to this claim by checking the appropriate box (e.g., if a Medicare claim is being filed, check the Medicare box).

Field Number : 1a
Field Description : Insured's ID number
Data Type : Required
Instructions : List the Insured’s identification number here. Verify that the identification number corresponds to the insured listed in item 4. The patient and the insured are not always the same person. Some payers assign unique identification numbers to each enrollee or dependent and require the number of the enrollee or dependent receiving services (the patient) instead of the insured’s number in this item.

Field Number : 2
Field Description : Patient's name
Data Type : Required
Instructions :  Enter the patient's last name, first name, and middle initial, if any.
NOTE: If the patient has a last name suffix (e.g., Jr, Sr) enter it after the last name, but before the first name. Do not use any punctuation in this field.

Field Number :  3
Field Description : Patient's birth date and gender
Data Type : Required
Instructions : Enter the patient's birth date and sex. Use the eight digit format (MM|DD|CCYY) format for date of birth. Enter an X in the correct box to indicate the sex of the patient. Only one box can be marked. If the gender is unknown, leave blank.



Field Number : 4

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