CMS 1500 Claim Form Questions & Answers Solved 100% Correct!!

The top portion of the claim form where the insurance company address is entered - Upper margin Where the insurance type is marked with an X - Block 1 Qualifier for DOA/Date of present illness block 14 - 431 Qualifier for LMP block 14 - 484 Referring Provider block 17 - DK Ordering provider block 17 - DQ Supervising provider block 17 - DK They are arranged in 8 digit formats MM/DD/YYYY only even though the field on the form says YY - How dates are arranged for DOB They can be 6 or 8 digit formats, but be consistent -How dates are arranged for DOS These codes are found in the CPT manual - Where are POS found? They're found in CPT and HCPCs manuals - Where are modifiers and their descriptions found? 10 digit number that recognizes providers with insurance companies; found at EIN: Employer Identification Number Providers who do not have a business/corporation IRS number have their revenue reported directly to their personal SS#. - SS: Social Security Number Medicaid related program for kids and family planning. Enter Y for yes, this was a Medicaid related kids screening or family planning service - EPSDT: Early & Periodic Screening, Diagnosis, and Treatment the healthcare provider who rendered the service; their NPI is listed in 24J of the claim form - Rendering provider the healthcare provider who suggested the patient come to have services with the provider we are billing for; their NPI is listed in 17a of the claim form - Referring provider the healthcare provider who orders the services listed in the claim; their NPI is listed in 17a of the claim form - Ordering provider the provider who oversees the work in incident to services; their NPI is listed in 17a of the claim form - Supervising provider when an NP/PA or other midlevel performs healthcare services under supervision - Incident to services Insured ID: block where the ID number for the claim representing how the insurance company will reference the patient's right to get care for this service - Block 1a The patient's name appears here in Last, First, Middle format with no punctuation except for the commas between and hyphenated names. As of July 2017 if the patient is the same as the insured, this field may remain blank. - Block 2