The Paper claim CMS-1500
Accept Assignment meaning in block 27 on the CMS1500 claim form
What is it indicates that the provider is or is not participating or accepting the patient's health insurance terms?
A _____ is a claim that was submitted within a third party payer's time limit and contains all necessary information so that it can be processed and paid promptly.
What is clean claim?
The CMS-1500 form has the ability to report ___ diagnostic codes
What is 12?
Do or don't?
Write in capitalized letters on the Claim Form?
What is DO?
Who developed a general instruction guide for completing the CMS-1500 claim form?
What is NUCC?
Developed the CMS-1500 claim form
What is National Uniform Claim Committee (NUCC)?
This place of service code is used for an office visit.
What is place of service code 11?
The policyholder, guarantor, and patient can be two or three different people
What is Yes, the policyholder is the person that took out the insurance contract. The Guarantor is the person responsible for paying the bill. The patient can be the dependent on the insurance policy?
True or false
It is okay to use punctuation marks on the CMS-1500 form.
What is false?
True or False
It is recommended that claims aren't processed using the NUCC guidelines.
What is False?
We enter this in Block 12 & Block 13 on the CMS1500 Claim Form
What is Signature on File (SOF) - Meaning the patient's signature is on file in the office?
A ____ is a claim submitted with errors, one requiring manual processing for resolving problems, or one rejected for payment.
What is dirty claim?
NPI stands for
What is National Provider Identifier ?
What is used to scan the majority of paper claims?
What is Optical character recognition (OCR)?
The carrier block can be found in the ____ corner of the CMS-1500 claim form.
What is upper right?
We place a "0" in the ICD indicator box in block 21 on the CMS1500 claim form meaning...
What is it indicates the version of the ICD diagnosis codes that we are using at the time of claim submission?
Ex. ICD-10-CM codes = "0"
A ____ is any Medicare claim missing required information
What is incomplete claim?
A health care organization may file taxes as a group and thus be under the same ____. This is added to block 25 on the CMS1500 claim form.
What is employer identification number (EIN) or tax identification number (TIN)?
DO or DON'T
Add the policyholder's name and DOB to the CMS1500 claim form, if different from the patient. Where would we add both?
What is DO?
Policyholder's name - Block 4
Policyholder's DOB - Block 11a
Located on the upper left corner of a CMS-1500 form
What is where the Quick response (QR) code symbol and the date approved by the NUCC is located?
True or False
The physician that you work for will allow you to place their rubber stamp signature on the claim form in Block 31.
What is True?
This block on the CMS1500 is used to make sure that the diagnosis & the procedure/service codes are medically necessary.
What is Block 24E (Diagnosis pointer)?
You would do this if the patient has two insurances to add to the CMS-1500 claim form?
What is Add the primary insurance information to blocks 1a, 11, 11c, & add the secondary insurance information to blocks 9, 9a, & 9d?
DO or DON'T
We will use both Block 32 & Block 33 when submitting a claim.
What is DON'T?
What block would we use to show who the referring provider was?
What is Block 17 - Name of referring provider& qualifier code &
Block 17b - Referring provider NPI # ?