Display Signed Medical Claim For Free

Box 19 on the CMS-1500 claim form allows healthcare providers to include additional information that may be crucial for accurately processing the claim. By providing relevant details about the patient's condition or the claim itself, you can ensure a smoother and more efficient claims process.

The applicable qualifier must be entered in Box 17 to identify the specific provider being reported. Common qualifiers include Referring Provider (DN) or Ordering Provider (DK), but it is important to consult the insurance payer to determine the correct qualifier for the referrer.

Box 23 - TITLE: Prior Authorization Number (this field is also used for CLIA numbers) ? INSTRUCTIONS: Enter any of the following: prior authorization number, referral number, or Clinical Laboratory Improvement Amendments (CLIA) number, as assigned by the payer for the current service.

32 Required Service Facility Location Information - Enter the provider name. Enter the provider address, without a comma between the city and state, and a nine-digit zip code, without a hyphen. Enter the telephone number of the facility where services were rendered, if other than home or office.

Box 17a. The Other ID number of the referring, ordering, or supervising provider is reported in 17a in the shaded area. The qualifier indicating what the number represents is reported in the qualifier field to the immediate right of 17a.

Box 23 - TITLE: Prior Authorization Number (this field is also used for CLIA numbers) ? INSTRUCTIONS: Enter any of the following: prior authorization number, referral number, or Clinical Laboratory Improvement Amendments (CLIA) number, as assigned by the payer for the current service.

Surprise out-of-network bills arise when a consumer receives care from an out-of-network provider in a situation she cannot reasonably control, such as being treated by an out-of-network anesthesiologist at an in-network hospital.