This article covers all the fields present within the CMS 1500 Claim Form. We’ll cover each numbered box and how the information pulls in from MacPractice, and the steps needed to pull information in the software, where it is appropriate and correct to do so.
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CMS 1500 Form Downloads for MP
If for some reason your copy of MacPractice does not include the CMS-1500 claim forms, you can download them in the following zip files. By extracting and double clicking on them, you can import them into your MP Server.
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Insurance Company and Address Information
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If this is a Worker's Compensation Claim, there are specific steps that must be taken. Refer to the Creating Worker's Comp Claims in MacPractice article for more information.
Box 5 - Patient's Address
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If the patient's relationship to the guarantor is set to Self, then Box 4 will print the word "Same" and Box 7 will be blank. Otherwise, the guarantor's Street Address, Suite / Apt. Number, City, State, and Zip code fields in the Primary or Secondary screen will be printed. The phone number will be populated from the first listed phone number set to the Home phone type.
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There are two exceptions to this rule:
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This box populates from the Birth Date field and Sex menu for the guarantor associated to the primary insurance.
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Box 11b - Other Claim ID (Designated by NUCC)
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It says:"INSURED'S OR AUTHORIZED PERSON'S SIGNATURE I authorize payment of medical benefits to the undersigned physician or supplier of services described below."
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Box 14 - Date of Illness, Injury, or Pregnancy (LMP)
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Navigate to Incident > Claims > Symptom Dates > First Symptom Date.
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(If on DDS, you'll navigate to the "CMS Claims" tab instead of Claims. If you don't see this tab, check Preferences > Ledger > Incident to enable "Display both CMS and ADA Claim View" and restart MacPractice.) |
Fill out the date, and then set the "First Symptom Date Type" to "Illness". The First Symptom date will pull to box 14 and print "431" in the Qual. box. This method requires that you utilize the CMS 02/12 form.
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For an Injury
Navigate to Incident > Incident Tab, then select the "Reason for Treatment" sub-tab. The date of injury pulls from Incident > Incident tab > Reason for Treatment > Accident Date > Condition Related To. Select a Condition Related to, then mark down the Accident Date. Depending on the option marked, box 10 may be checked for the appropriate options.
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This field pulls from the National Provider ID (NPI) field found under the Provider IDs tab of the Referral Reference. This information will populate this field when the Referral is entered in the charge window.
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Box 18 - Hospital Admission and Discharge Dates
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The default CMS 1500 form does not pull this information in automatically. Offices may choose to write this in by hand, or update their CMS Form Reference to a custom Form that allows you to type this information in when generating a claim. This Custom CMS 1500 with resubmission fields is attached to the bottom of this article for your use.included here:
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This Custom form pulls in the Resubmission Code and Resubmission Reference fields from the Claim Creation Window, on the far right of the claim creation table as shown in the below screenshot.
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The patient must have an Insurance Plan selected. They must also have the Plan Type set to Medicare Part B in the Patient's Insurance Company Reference > Plans Tab.
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For other claim types: This information is populated into the claim when an insurance requires a Prior Authorization number. It is pulled from the Prior Authorization number entered and insurance pop-up menu selected on the Prior Auth tab of the Incident.
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Information is populated from the Code and Modifier fields in the charge window.
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Box 24e - Diagnosis Pointers
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If Medicare is the insurance, this box will only print a single diagnosis pointer. If there are multiple procedures on the claim that have different primary diagnosis, the pointer for the charge's primary diagnosis will pull into this field.
CMS 1500 (02/12) Box 24f - Charge Amounts
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This box will only populate when using the CMS 1500 (02/12) NPI and Legacy form AND the form AND the "Leave 24 I/J Blank" checkbox is unchecked in References > Insurance Companies > Claims Tab.
This information pulls from the Qualifier Code (box 24) that is selected in the menu under the Provider IDs tab of the Insurance Company Reference. When this is set to "Automatic", the two digit code based on the Plan Type menu selection in the Insurance Company Reference will be printed.
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Box 24j - Rendering Provider Numbers
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For more information on the Office Reference and how to get this adjusted, please refer to References - Offices.
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Box 33a - Billing Provider NPI Number
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If the "Bill as Individual" box is checked in the Provider IDs tab of the Insurance Company Reference, this information will pull from the National Provider ID (NPI) field entered in the User Reference for the provider.
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Box 33b - Billing Provider Legacy Numbers
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