FAQ: Understanding Box 17-23 on CMS-1500 for Claim Filing

👉👉✅Mastering Box 17-23: A Guide to Filing Claims with CMS-1500✅👈👈


1. What information is required in Box 17 on the CMS-1500 form?

Box 17 on the CMS-1500 form is allocated for the referring, ordering, or supervising physician's information. It should include the referring provider's name and credentials in the format of 'Last Name, First Name'. Do not include any suffixes like Jr. or III. Remember to include the provider's credentials (MD, DO, PhD, etc.) after their name.

2. Why is Box 17 important when filing a claim?

Box 17 is important because it directly impacts the processing and payment of your claim. Including accurate and complete information about the referring provider ensures the claim is correctly associated with the appropriate physician.

3. What should be provided in Box 18 of the CMS-1500 form?

Box 18 requires the specification of hospitalization dates related to the current services. You need to provide precise admission and discharge dates to establish a link between the reported services and a hospital stay.

4. Why is it important to provide accurate hospitalization dates in Box 18?

Accurate hospitalization dates in Box 18 help insurance providers determine if the reported services were indeed connected to a hospital stay. Providing correct information avoids confusion and helps ensure a smooth claim processing experience.

5. What is the purpose of Box 19 on the CMS-1500 form?

Box 19 serves as a catch-all for additional claim details. It can include resubmission codes or original reference numbers for corrected or voided claims. Use this box to provide any additional narratives or information that supports your claim.

6. How should Box 20 of the CMS-1500 form be completed?

Box 20 is designated for the 'Outside Lab?' question, which determines if the tests were performed by an outside laboratory. You should indicate 'Yes' or 'No' accordingly and provide the charge amount for those services if applicable.

7. What information should be included in Box 21 of the CMS-1500 form?

Box 21, labeled 'Diagnosis or Nature of Illness or Injury,' requires listing the patient's diagnoses using the most current version of the International Classification of Diseases (ICD). When reporting multiple diagnoses, list them in order of significance related to the services provided.

8. What does Box 22 of the CMS-1500 form pertain to?

Box 22 is for the resubmission of a claim or changes made to a previously submitted claim. Include resubmission codes and the original reference number to ensure proper processing and referencing of the claim.

9. What information should be provided in Box 23 of the CMS-1500 form?

Box 23 is for the inclusion of the prior authorization or referral number. Insurance companies often require preauthorization for certain procedures or treatments. Providing this information in Box 23 helps expedite claim processing.

10. Why is it important to understand and properly complete Boxes 17-23 on the CMS-1500 form?

Understanding and correctly completing Boxes 17-23 on the CMS-1500 form is crucial for successful claim submission. Each box serves a specific purpose and contributes to the accuracy and completeness of the claim. Filling these boxes correctly increases the likelihood of your claims being accepted on the first submission.