What Is Box 32 On A HCFA?

What goes in box 32a on CMS 1500?

Item 32 Form CMS-1500 (08-05) – Enter the name and address, and ZIP Code of the facility if the services were furnished in a hospital, clinic, laboratory, or facility other than the patient’s home or physician’s office..

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 is a CMS 1500?

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 a ub04?

The Uniform Billing Form – known either as the UB-04 or CMS 1450 – is the standard for billing all major insurance providers as well as Medicare. The form contains more than 80 lines for important patient information.

What box does the CLIA number go in on a CMS 1500?

Clia number in CMS 1500 On each claim, the CLIA number of the laboratory that is actually performing the testing must be reported in item 23 on the CMS-1500 form. Referral laboratory claims are permitted only for independently billing clinical laboratories, specialty code 69.

What is box 33a on a HCFA?

Box 33a is used to indicate the National Provider Identifier number of the Billing Provider.

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

Diagnosis pointer letters A-L are preprinted in Block 21 of the CMS -1500 claim to allow for entry of _____codes, and they are reported in Block 24 E. You just studied 27 terms!

How many numbers should be entered for the patient’s birth in block Item 3?

8This is a required field. Item 2 – Enter the patient’s last name, first name, and middle initial, if any, as shown on the patient’s Medicare card. This is a required field. Item 3 – Enter the patient’s 8-digit birth date (MM | DD | CCYY) and sex.

What goes in box 32b on a HCFA?

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.

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.

How many boxes does UB 04 have?

Understanding the UB-04 Fields. There are 81 fields (or lines) on a UB-04 form. These are referred to as form locators or “FL.” Each form locator has a unique purpose for the insurance carrier and provider so that they can communicate.

What is DN qualifier?

It appears our system hard-codes the DN qualifier which is referring providers for the old form. With the new form, the treating provider is the same as the ordering provider for radiology services.

What goes in box 17a on CMS 1500?

What is it? Box 17a is the non-NPI ID of the referring provider and is a unique identifier or a taxonomy code. The qualifier indicating what the number represents is reported in the qualifier field to the immediate right of 17a.

How many blocks is a UB 04 claim?

There are 81 fields or lines on a UB-04. They’re referred to as form locators or “FL.” Each form locator has a unique purpose: Form locator 1: Billing provider name, street address, city, state, zip, telephone, fax, and country code.

Who will use UB 04 claim form for billing the medical services?

If you work in a medical clinic, hospital, rehabilitation center or nursing home, then you would use the UB-04 claim form for billing purposes. If you are a physician or doctor, then you should fill out the CMS-1500 claim form to complete your billing.