CMS ACRONYMS
WHAT DOES THE ACRONYM SOF STAND FOR?
SIGNATURE ON FILE
WHAT INFORMATION GOES INTO BOX# 3
PATIENT DATE OF BIRTH and THE GENDER
WHAT GOES IN BOX#24 J
WHAT GOES IN BOX 24D?
CPT/HCPCS CODES
PRIOR AUTHORIZATION NUMBERS GO IN WHICH BOX?
23
WHAT DOES EIN STAND FOR?
EMPLOYER IDENTIFICATION NUMBER
WHAT INFORMATION GOES INTO BOX#5?
PATIENT ADDRESS
CITY, STATE, ZIP CODE and TELEPHONE NUMBER
WHAT GOES INTO BOX# 32a?
WHAT GO IN BOX#24F?
CHARGES
SIGNATURE ON FILE GO IN WHICH BOXES?
12 & 13
WHAT DOES EMG STAND FOR?
EMERGENCY
WHAT GOES IN BOX# 4?
THE INSUREDS NAME
(SAME IF THE INSURED IS THE PATIENT)
WHAT GOES IN BOX# 25?
PROVIDER FEDERAL TAX ID#
SSN OR EIN
WHAT GO IN BOX#29?
9a
WHAT DOES FECA STAND FOR?
FEDERAL EMPLOYEES COMPENSATION ACT
WHAT GOES IN BOX#6
RELATIONSHIP TO THE INSURED
SELF
SPOUSE
CHILD
OTHER
WHAT GOES IN BOX#27?
ACCEPT ASSIGNMENT YES OR NO BOX
WHAT GO IN BOX #24 G
DAYS AND UNITS
4
WHAT DOES EPSDT STAND FOR?
EARLY and PERIODIC SCREENING, DIAGNOSTIC and TREATMENT
WHAT GOES IN BOX# 11 AND 11a
11 - INSURED'S POLICY/GROUP NUMBER
11a - INSURED'S DATE OF BIRTH AND GENDER
WHAT GOES IN BOX# 33?
BILLING PROVIDER INFORMATION
ADDRESS
CITY, STATE, ZIP CODE
PHONE NUMBER
WHAT GO IN BOX#21
PATIENT DIAGNOSIS
IN BOX 1 THERE ARE HOW MANY BOXES FOR INSURANCE CARRIERS?
7