Jane is now able to generate a CMS 1500 form into an editable PDF!
Here’s the information you need to ensure all the data is populated onto the form.
Clinic Settings
1. Each of your US insurers should have an address and the type of Insurance Program selected.
Under Settings > Insurers >, click View to check that an insurance program has been selected:
2. Set your NPI and place of service code for the clinic.
Head to Settings > Clinic Info & Locations, scroll down and click into your location.
At the bottom you’ll see the area to add this information:
Staff Settings
3. In the “ID Numbers” section of a staff profile add both NPI (National Provider Identifier) and either SSN, TIN or EIN federal tax ID numbers.
Note: Jane only places one Federal Tax I.D on the form, so she will prioritize SSN then, EIN and finally the TIN.
Jane will use these to populate on to the CMS1500:
Claim Settings
When you create a claim for a patient, you can enter all the relevant details for that patient and their claim:
The information on the above area (see screenshot about) of the claim will populate on a CMS-1500 form as follows:
- Claim Identification Number: Box 1a
- Policy Number: Box 11
- Insurance Plan Name: Box 11c
- Prior Authorization Number: Box 23
The information on the above area (see screenshot about) of the claim will populate on a CMS-1500 form as follows:
- Injury Date: Box 14
- Signature on File: Box 13
- Accept Assignment: Box 27
The information on the above area (see screenshot about) of the claim will populate on a CMS-1500 form as follows:
- Insured’s Info: Box 6, 7, & 9
- Is the patient’s condition related to: Box 10
- Date of Current Illness Injury, or Pregnancy: Box 14
- Enter Another date related to the patient’s condition or treatment: Box 15
- Dates Patient Unable to Work in Current Occupation: Box 16
- Hospitalization Dates Related to Current Services: Box 18
The information on the above area (see screenshot about) of the claim will populate on a CMS-1500 form as follows:
- Name and ID numbers of who referred or ordered the service(s) or supply(ies): Box 17
Generating the CMS1500
Once you have added the claim to the appointment and Arrived the appointment, click the downward arrow next to the “Pay” button and select Generate CMS1500:
Jane will tell you if there are any missing fields and then generate the form.
This form can be edited further if required. Save or Print from there;
Note: SOF stands for Signature on File.
This is an accepted term but feel free to remove this is you are printing and signing.
These will print best on blank paper and you’ll need to print in colour if you require the red form for Medicare purposes.
Want to export multiple CMS-1500 forms in one go? If so, check out the following guide: Generating a Batch: Superbills & CMS-1500s
Happy Billing!