Click the image for see full size sample CMS 1500 claim form.
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The other ID number of the referring provider, ordering provider, or other source should be reported in 17a in the shaded area. The qualifie...
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Corrected Claims A corrected claim is a claim that has already been processed, whether paid or denied, and is resubmitted with additional...
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For Adjustments: When requesting an adjustment to a paid claim, enter an “A” followed by the 13-character internal control number (ICN) as...
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How should I list the name of the ordering/referring provider when submitting my paper and electronic claims? Answer: Paper Claims- Blo... -
FLs 18 thru 28. Condition Codes. a. Each code is two numeric digits. b. If code 07 is entered, type of bill must not be hospice 81X or 8...
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DISCHARGE STATUS This field identifies the discharge status of the patient at the statement through date. This is a two-position alphanum...
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“CLIA” - The Clinical Laboratory Improvement Act and CMS implementing regulations and processes. A paper claim for laboratory testing ...
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Item 17 Enter the name of the referring or ordering physician if the service or item was ordered or referred by a physician. All physicia...
For Fillable 1500 form, you can find it at here at PDFfiller.com or you can follow this link - http://goo.gl/3AdnKC
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