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Box 24

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Box 24- Service Lines Shaded (1-6)

What’s in the box?

This box is used to communicate additional information about the service line.

When submitting to secondary payers, oftentimes adjudication information from the primary payer is sent in this line.

Where does this info live in Jane?

We don’t currently support this box, as we don’t support submission to secondary payers. Please add your vote to our Secondary Claims feature request to stay updated: Ability to create a submission for a secondary Insurance claim

In the meantime, you can manually add info to this box after generating a CMS1500.
 

Box 24a- Date(s) of Service

What’s in the box?

This box indicates the date a procedure was performed. It contains a section for a From and To date, but these dates will always be the same in Jane.

📌 Note: If your practice would like to be able to include a different a date range in this box, let us know why!

Where does this info live in Jane?

The date of the appointment on the Schedule (or purchase date of the product) is automatically used for every procedure.

Is this required?

Yes - but there’s nothing extra you have to do to set this box.


What about the EDI file?

The Date of Service is sent in Loop 2400 - Service Line Info

  • For each procedure billed on a claim, the Date of Service is sent in Loop 2400, DTP03
    • DTP01 includes the qualifier 472, which means Service
       

Box 24b- Place of Service Code

What’s in the box?

The Place of Service (POS) code identifies the type of location where the service was rendered. There is a spot for a POS code for each procedure being billed.

Where does this info live in Jane?

When creating or editing a Location (Settings > Clinic Info & Locations > Edit/New Location), you can assign a default POS code at bottom of the Location page.

Each POS code is two digits, and we regularly update our list. If you can’t find a POS code that you need, then let us know and we’ll add it!

Is this required?

Although this information is not required when creating/editing your Location in Jane, it is required when billing a CMS1500 or EDI file.


What about the EDI file?

The Place of Service code is sent in Loop 2300 - Claim Info.

Specifically:

  • The Place of Service Code is sent in Loop 2300, Segment CLM05


 

Box 24c- Emergency Service

What’s in the box?

This Box indicates that the procedure was performed to address a medical emergency.

Where does this info live in Jane?

This box is not currently supported in Jane (blank by default on the CMS1500). If your practice would like this box to be supported, let us know!
 

Box 24d- CPT & Modifier(s)

What’s in the box?

This Box indicates the procedure that was performed (applicable CPT code) as well as any Modifiers (limit of 4) made on the procedure.

On each claim form, a maximum of 6 procedures can be billed.

📍 Key Note: This limit only applies to the CMS1500. The limit of 6 procedures doesn’t apply to electronic submissions.

Where does this info live in Jane?

You can add CPT codes to an appointment in multiple areas of Jane. From the Schedule, you can add CPT codes under the Insurance Info section of the Appointment Panel.

Once you’ve added a code, you’ll be given the option to add a Modifier. There’s a little box under each CPT where you can do this. Simply type in your two-digit Modifier, and press the Enter on your keyboard.

📍Key Note: The order of the CPT codes on your claim form mirrors the order of the codes attached to the Insurance Policy in the Appointment Panel.

Before you start billing Insurance, you’ll want to make sure you’ve assigned fees to your CPT codes. This can be done in Settings > Billing Codes. For more info on setting up your billing codes, check out our Insurance Billing Course: US Insurance Step 2.

For more info on adding CPT codes to your appointments, have a look at the following guide: Start Billing 2: CPT & Diagnosis codes.

Lastly, you can save some time when billing by setting up some Default Modifiers. To learn how, you can check out our guide on Billing Code Default Allowed Amounts & Modifiers.

Is this required?

You need at least one CPT code to bill a claim, but Modifiers are optional. You should follow instructions from the Insurance company if you’re unsure about Modifier requirements.


What about the EDI file?

CPT code info is sent in Loop 2400 - Service Line Info.

An SV1 segment is sent for each CPT code on the claim.

  • SV101 includes both the CPT code and any modifiers assigned to that code
    • SV101-02 includes the CPT code
    • SV101-03 includes the CPT code modifier(s)


 

Copy of Box 24e - Diagnosis Pointer

What’s in the box?

This Box ‘points’ to the applicable diagnosis codes reported in Box 21 for each CPT code (i.e. Procedure 99204 was performed to treat the diagnosis A, B, and C). Note that the first code listed is the primary diagnosis.

Where does this info live in Jane?

Diagnosis codes can be added to an Appointment as soon as you’ve added the CPT code(s). There’s a little box under each CPT code where you can add and rearrange your diagnosis codes.

For more info on adding CPT & diagnosis codes to your appointments, you can check out our guide: Start Billing 2: CPT & Diagnosis codes.

Is this required?

Yes. Each procedure needs to point to at least one diagnosis code. However, Jane assigns the pointers on the claim for you based on which diagnosis codes you’ve added— and the order in which you’ve added them— to the appointment.


What about the EDI file?

CPT code info is sent in Loop 2400 - Service Line Info.

An SV1 segment **is sent for each CPT code on the claim.

  • SV101 includes the CPT code
  • SV107 includes the diagnosis code pointers
    • Each sub-element of SV107 points to a specific diagnosis code. A procedure can point to a maximum of 12 diagnosis codes.
      • The first diagnosis code (sub-element SV107-01) is the primary diagnosis for the procedure. Subsequent diagnosis codes are listed in an order of declining importance to the procedure.

📍 Pro Tip

On the CMS1500, diagnosis pointers are managed with letters (A-L) but on the EDI they are managed with numbers (1-12).


 

Box 24f - Charges (CPT Price)

What’s in the box?

This Box indicates the price of a procedure (CPT code). Note that Box 28 reflects the sum of all procedure charges.

Where does this info live in Jane?

Before you start billing Insurance, you’ll want to make sure you’ve assigned fees to your CPT codes. This can be done in Settings > Billing Codes. For more info on setting up your billing codes, check out our Insurance Billing Course: US Insurance Step 2.

For more info on adding CPT codes to your appointments, have a look at the following guide: Start Billing 2: CPT & Diagnosis codes.

Jane uses the price assigned to the CPT code (Settings > Billing Codes) for each procedure on the CMS1500.

📍 Key Note: The price of the treatment (which is configured in Settings > Treatments & Classes) is not considered when billing Insurance. When you add a billing code to a visit in Jane, the billing code fee overrides the price of the treatment (aka your ‘cash’ price).

Is this required?

Yes! A claim must have at least one CPT code, and if you don’t assign a price to your CPT codes, it will look like you’re billing $0 claims.


What about the EDI file?

CPT code fees are sent in Loop 2400 - Service Line Info.

An SV1 segment **is sent for each CPT code on the claim.

  • SV101-02 includes the CPT code
  • SV102 includes the price of the CPT code


 

Box 24g - CPT Units

What’s in the box?

The number of billed units of a particular CPT code.

Where does this info live in Jane?

After adding a CPT code to an Appointment, you can change the number of units simply by clicking on the price of the code.

For more info on adding CPT codes to your appointments, have a look at the following guide: Start Billing 2: CPT & Diagnosis codes.

Is this required?

Yes - each CPT code needs an assigned number of units. By default, CPT codes are billed for a single unit in Jane.


What about the EDI file?

CPT code info is sent in Loop 2400 - Service Line Info.

An SV1 segment is sent for each CPT code on the claim.

  • SV101 includes the CPT code
  • SV102 includes the price of the CPT code
  • SV103 is hardcoded to UN, which indicates the procedure is billed in terms of units > 📍 Note: we always send UN, but it is possible that some providers need to bill in minutes instead of units, in which case MJ would be needed. We don’t currently support minutes, but let us know if this is something your practice needs!
  • SV104 includes the number of units


 

Box 24h - EPSDT/Family Planning

What’s in the box?

Box 24h is used to identify services that may be covered under specific state-funded plans.

Where does this info live in Jane?

This box is not supported in Jane (blank by default on the CMS1500). If your practice would like this box to be supported, let us know!
 

Box 24i - Rendering Provider ID Type

What’s in the box?

This box indicates the type of identifying number that is reported in box 24j of the CMS1500. This info helps the Insurer identify the rendering provider.

There is a shaded and unshaded section of Box 24i for each service line.

Unshaded:

  • Includes text ‘NPI’ by default.

Shaded:

  • Blank by default.
  • Only used if a non-NPI rendering provider identifier (i.e. staff License number) or Rendering Provider Taxonomy Code needs to be reported.
  • If the shaded area of box 24i is used, then a 2-digit qualifier will be sent to identify the type of number being reported in box 24j.

Here’s a list of qualifiers that are currently supported:

State License (OB)

Provider UPIN (1G)

Provider Commercial Number (G2)

Location Number (LU)

Taxonomy (ZZ)

Where does this info live in Jane?

The Rendering Provider ID is set within a Staff Member’s Billing tab, specifically within the Default Claim Information or within an Insurance Specific Claim Information form.

There’s nothing extra required to set box 24i if the Insurance company requires an NPI to identify the rendering provider!

However, if the Insurance company requires a License number (a non-NPI ID), then you will need to click the ‘Use License Number instead of NPI?’ option when setting up your claim information and enter a License Number and License Type. The License Type will set the qualifier in box 24i of the CMS1500.

📍 Key Note: The majority of Insurance companies require a Rendering Provider NPI. Only use a Rendering Provider License Number if advised to by the Insurance company.
If an Insurance company requires a Taxonomy Code to accompany the Rendering Provider NPI, then the qualifier ‘ZZ’ will be set in the shaded area of box 24i.

Is this required?

You are required to specify the types of numbers that identify the Rendering Provider.


What about the EDI file?

The Rendering Provider ID Type is sent in Loop 2310B - Rendering Provider Info. What qualifier is used and where it’s sent depends on whether the ID is an NPI (most common) or a License Number.

  1. If an NPI is used, then the ‘XX’ qualifier will be included in Loop 2310B, Segment NM108.
    • If a Taxonomy Code is sent along with an NPI, then it is sent in Loop 2310B, Segment PRV.
      • The qualifier ‘PXC’, which is the EDI qualifier for Taxonomy Codes, is sent in PRV02
      • The Taxonomy Code is sent in PRV03
  2. If a License Number is used, then the License Number Type you’ve selected will determine the qualifier sent in Loop 2310B, Segment PRV02.

Here is the list of Rendering Provider IDs available in Jane with their qualifiers in brackets:

  • NPI (XX)
  • State License (OB)
  • Provider UPIN (1G)
  • Provider Commercial Number (G2)
  • Location Number (LU)
  • Taxonomy (PXC)


 

Box 24j - Rendering Provider ID Number

What’s in the box?

This box is used by the Insurer to identify the provider who performed the service— the Rendering Provider. Note that this box is closely linked with Box 24i, as well as the other sub-sections of box 24.

There is a shaded and unshaded section of Box 24j for each service line.

Unshaded:

  • The Rendering Provider NPI is reported in the unshaded section
  • If a Rendering Provider License ID is used in place of an NPI, then this section is left blank.

Shaded:

  • In some cases, an Insurer may require that a License or PIN be used instead of the NPI to identify the Rendering Provider. In these cases, the shaded section is used to report the license number.
  • Some Insurers require the Rendering Provider to report the Taxonomy Code assigned to their NPI. In these cases, the Taxonomy Code is set in this box.

Where does this info live in Jane?

The Rendering Provider ID of the staff member receiving compensation for the visit is used in Box 24j. This is typically the staff member who the patient is booked in with, but not always (see the Billing Under a Different Staff Member section below for more info).

You can check which Staff member is receiving compensation for an Appointment by hovering your mouse over the Billing Info section of the Appointment Panel and clicking the blue View button that appears.

Rendering Provider IDs are set within a Staff Member’s Billing tab, specifically within the Default Claim Information, or within an Insurance Specific Claim Information form.

The Rendering Provider ID can either be set by adding a Rendering Provider NPI or a License Number. Note that only one Rendering Provider ID can be set (Either an NPI, or a license number, but not both).

Typically, the Rendering Provider NPI will be used as the Rendering Provider ID, but in some cases, an Insurance company may identify the rendering provider with a non-NPI identifier. In these cases, click the ‘Use License Number instead of NPI?’ option and enter a License Number and License Type

📍 Key Note: The majority of Insurance companies require a Rendering Provider NPI. Only use a Rendering Provider License Number if advised to by the Insurance company.

📍 Pro Tip: Rendering Provider Taxonomy Codes- Some Insurance companies require the main Taxonomy Code assigned to the Rendering Provider NPI in order to identify the Rendering Provider.

Billing Under a Different Staff Member

If you need to bill a claim under a different provider, then you’ll need to change the staff member receiving compensation for the Purchase. By default, the staff member receiving compensation will be the staff member with whom the patient is booked.

For example, let’s say that Andy is a student practicing under Susan. Some visits are booked in Andy’s Schedule, but we need to bill claims for those appointments under Susan’s credentials.

For each Insured visit in Andy’s Schedule, we’ll need to edit the Purchase and change the staff member receiving compensation from Andy to Susan.

To do this, you can hover your mouse over the Billing Info section of the Appointment Panel and click the blue View button that appears. This will lead you to the Purchase screen, where you can use the blue Change text next to the Staff Member’s name to switch Practitioners.

Keep in mind that making this change will also affect your Reports. For example, each visit where the staff member receiving compensation is changed will show up under Susan’s Sales and Compensation Reports (instead of Andy’s).

Is this required?

A Rendering Provider ID (NPI or License) is required when billing paper and electronic claims. A Rendering Provider Taxonomy Code is optional.


What about the EDI file?

The Rendering Provider ID is sent in Loop 2310B - Rendering Provider Info. Where it’s sent depends on whether the ID is an NPI (most common) or a License Number.

  1. If an NPI is used, then it will be included in Loop 2310B, Segment NM109.
  2. If a License Number is used, then it will be included in Loop 2310B, Segment REF02.
    • Note that the License Number Type (the ‘qualifier’) will be included in Loop 2310B, Segment REF01 - but this maps to box 24i on the CMS1500

    Here is the list of Rendering Provider IDs available in Jane with their qualifiers in brackets:

    • NPI (XX)
    • State License (OB)
    • Provider UPIN (1G)
    • Provider Commercial Number (G2)
    • Location Number (LU)
    • Taxonomy (PXC)
  3. If a Rendering Provider Taxonomy Code is used, then it is sent in Loop 2310B, Segment PRV
    • The qualifier ‘PXC’, which is the EDI qualifier for Taxonomy Codes, is sent in PRV02
    • The Taxonomy Code is sent in PRV03