Medical billing CMS 1500 - hint & tips to complete claim
CMS1500 FL # Description of Information Required
1a Patient’s ID Number
2 Patient’s Name, as it appears on identification card
3 Patient’s Date of Birth (mm/dd/ccyy) and Sex
4 Subscriber’s Name—if same as patient, enter SAME.
5 Patient’s address—if different from subscriber’s, complete item 7
9-9d Other insurance information—if applicable. DOB must be in mm/dd/ccyy format.
10a-c If services are related to patient’s employment, auto accident or other accident, please complete. Otherwise leave blank.
11a-c Subscriber’s Insurance Group Number, Subscriber’s DOB (mm/dd/ccyy), Subscriber’s Sex
11d “Yes/No”—If “yes”, complete Item 9.
14 Date of onset of current illness or injury. (Use LMP for pregnancy)
17 Name of referring physician—required for lab and radiology claims only
17a Shaded area—Legacy qualifier / legacy number of referring physician (legacy qualifiers—1G for UPIN; G2 for MHP ID; 1C for PIN)
17b NPI of referring physician
18 Admission and discharge
