Which is entered in Block 11c of the CMS 1500?

Asked by: Kirsten Gorczany  |  Last update: February 11, 2022
Score: 4.7/5 (50 votes)

Item 11c-Insurance plan name or program name: Enter the nine-digit payer identification (ID) number of the primary insurance plan or program. If no payer ID number exists, enter the complete primary payer's program name or plan name.

Which is entered in Block 11c of the CMS-1500 quizlet?

Deductibles, copayments, and coinsurance are covered by what type of plan? Which is entered in Block 11c of the CMS-1500? accident. is divided into four consecutive quarters.

What goes in box 11 on a CMS-1500?


If YES is checked in Box 11d, enter the month, day and year the policyholder was born.

When you type signature on file in block 12 on the CMS-1500 means a patient has signed a N?

Entering SIGNATURE ON FILE in block 12 of the CMS-1500 claim means that, in order to release medical information to the payer, the patient has signed a(n): b. authorization. What kind of claim is used for billing provider fee-for-service claims to commercial health insurance companies?

Which of the following is the correct date pattern to be used in block 24A on a CMS-1500 claim?

If there is a change in the insured's insurance status, e.g., retired, enter the word "Retired" followed by the six-digit or eight-digit retirement date (MM/DD/CCYY). When reporting a date in Item 24A, it must be one continuous number (i.e., MMDDCCYY), without spaces between month, day, and year.

Lesson #1 CMS 1500 Demonstration

32 related questions found

Which CMS 1500 block requires entry of either the social security number?

Field 1A of the CMS 1500 form requires a patient's social security number.

What information is entered into block 4 on the CMS 1500 claim for a workers compensation case?

Enter the insured's address and telephone number. If Block 4 is completed, this field should be completed. The first line is for the street address; the second line is for the city and state; the third line is for the zip code and phone number.

What is Block 12 on the CMS-1500 form?

Box 12 is the “release of information” box. Many billers think that if you don't have to release any information, you can just leave this blank. Others think you just stick “signature on file” there and you're good.

What goes in box 19 on a CMS-1500?

Box 19. Box 19 is commonly used on paper claims for data not otherwise accommodated by the CMS-1500 claim form. Data entered in this field will print but will NOT export electronically. Please contact your payer to determine where the data is expected.

What is the field 12 in CMS-1500 claim form?

12 Patient's or Authorized Person's Signature Yes Enter the patient's or authorized person's signature. Signature on File or "SOF" are acceptable. If the claim is for a Lab or DME provider "No Signature on File" or "Patient Not Present are also acceptable." ... Signature on File or "SOF" are acceptable.

What goes in box 33 on a CMS-1500?

What is it? Box 33 is used to indicate the name and address of the Billing Provider that is requesting to be paid for the services rendered. Enter the name, address, city, state, and ZIP code.

What goes in box 32a on CMS-1500?

Box 32a: If required by Medicare claims processing policy, enter the National Provider Identifier (NPI) of the service facility.

What is entered in the shaded areas of Block 24?

What is it? Section 24 is used to list the completed services for the claim. The 6 service lines have been divided horizontally. The shaded area of each line between 24A and 24G is the location for reporting supplemental information.

What should be entered in field 24E of the CMS-1500 claim form to correctly the diagnosis to the service?

Item 24E - This is a required field. Enter the diagnosis code reference number or letter (as appropriate, per form version) as shown in item 21 to relate the date of service and the procedures performed to the primary diagnosis. Enter only one reference number/letter Page 17 per line item.

What is typically covered by supplemental plans?

Some of the most common types include accident, hospital, critical illness, dental and vision. Supplemental plans can help you pay for medical expenses that your regular policy may not cover, such as deductibles and copayments. You can also buy supplemental plans to cover vision care and dental expenses.

What goes in box 29 on a CMS-1500?

Box 29 is used to indicate the payment received from the patient and other payers. Dollar signs, commas, and negative amounts are not allowed. If the amount is a whole number, enter 00 as the cents. Note: Per Medicare guidelines, 0.00 should be entered as the amount paid by the previous payers.

What is Box 22 on CMS-1500 form?

Complete box 22 (Resubmission Code) to include a 7 (the "Replace" billing code) to notify us of a corrected or replacement claim, or insert an 8 (the “Void” billing code) to let us know you are voiding a previously submitted claim.

How many boxes are in a CMS-1500?

Enter the patient's 8-digit birth date (MM | DD | CCYY) and sex. Only one box should be indicated; either M or F.

Where is the carrier block located on the CMS-1500?

The carrier block is located on the upper right of the CMS-1500.

Which are preprinted in Block 21 of the CMS-1500 claim?

Item numbers 1 through 4 preprinted in Block 21 of the CMS-1500 claim. The act that regulates disclosure of confidential information. prohibts a payer from notifying the provider about payment or rejection of unassigned claims or payments sent directly to the patietn patient/policyholder.

What is a CMS 1450 form?

The Form CMS-1450, also known as the UB-04, is the standard claim form to bill Medicare Administrative Contractors (MACs) when a paper claim is allowed. ... In addition to billing Medicare, the 837I and Form CMS-1450 may be are sometimes suitable for billing various government and some private insurers.

What is NUCC on 1500 form?

This document is published in cooperation with the National Uniform Claim Committee (NUCC) by the American Medical Association (AMA). ... Any user of this document should refer to the most current federal, state, or other payer instructions for specific requirements applicable to using the 1500 Claim Form.

What is a CMS-1500 form quizlet?

CMS-1500. Claim form used to submit paper claims fo services and procedures rendered by physicians and other health care professional on an outpatient basis. Continuity of care. Coordinating treatment and health services between patients' health care providers.