Tuesday, November 2, 2010

Box 23 - cms 1500 - when to use authorization or CLIA or zip code on

Prior Authorization Number

This is a required field for the purposes outlined below.

• Enter the Quality Improvement Organization (QIO) prior authorization number for those procedures requiring QIO prior approval.

• Enter the Investigational Device Exemption (IDE) number when an investigational device is used in an FDA-approved clinical trial. Post Market Approval number should also be placed here when applicable.

• Enter the 10-digit Clinical Laboratory Improvement Act (CLIA) certification number for laboratory services billed by an entity performing CLIA covered procedures.

• Enter the ZIP code for the point of pickup for ambulance claims. Because the ZIP code is used for pricing, more than one ambulance service may be reported on the same claim for a beneficiary if all
points of pickup are located in the same ZIP code. However, suppliers must prepare a separate claim form for each trip if the points of pickup are located in different ZIP codes. A claim without a ZIP code or with multiple ZIP codes will be denied as unprocessable.

NOTE: Item 23 can contain only one condition. Any additional conditions should be reported on a separate CMS–1500 Form.

Prior Authorization Number Needed on CMS 1500 Claim Form 

Include the prior authorization number in box 23 of the CMS 1500 claim form. If you forget, our claim system will match the prior authorization number that’s on file.

Box 23 - Prior Authorization number

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