Full Answer
What is box 17 on the CMS 1500 form?
Monday, January 13, 2014 New CMS 1500 form update BOX 17 Item 17 - Enter the name of the referring or ordering physician if the service or item was ordered or referred by a physician. All physicians who order services or refer Medicare beneficiaries must report this data.
Is box 17A required by Medicare?
Note: Box 17a is not required by Medicare. Be sure to verify requirements with other payers. NPI of the Referring/Ordering Physician - Enter the NPI of the referring, ordering, supervising physician or non-physician practitioner listed in item 17.
When to use a separate CMS-1500 claim form for multiple physicians?
When a claim involves multiple referring, ordering, or supervising physicians, use a separate CMS-1500 claim form for each ordering, referring, or supervising physician. Enter the qualifier to the left of the dotted vertical line on item 17. This block is not used after May 23, 2008.
How do I enter the qualifier on item 17?
Enter the qualifier to the left of the dotted vertical line on item 17. NOTE: Under certain circumstances, Medicare permits a non-physician practitioner to perform these roles.
What is a qualifier in box 17?
What is it? Box 17 identifies the name of the referring provider on the claim. Enter the applicable qualifier to the left of the vertical dotted line to identify which provider is being reported.
What goes in box 17 on a CMS-1500?
Referring and Ordering PhysicianEnter the name of the referring or ordering physician if the service or item was ordered or referred by a physician. All physicians who order services or refer Medicare beneficiaries must report this data.
What qualifier should be listed in block 17 for a referring provider?
The qualifiers appropriate for identifying an ordering, referring, or supervising role are as follows: • DN -- referring provider • DK -- ordering provider • DQ -- supervising provider • Enter the qualifier to the left of the dotted vertical line on item 17.
Does CMS-1500 require Box 17?
The NPI may be reported on the CMS-1500 Form (08-05) as early as January 1, 2007. An invalid NPI will cause the claim to be rejected as unprocessable. NOTE: Field 17a and/or 17b is required when a service was ordered or referred by a physician.
What is a qualifier on a CMS 1500?
1D and G2 are the qualifiers that apply to the IHCP provider number, also called the LPI for the atypical non-health care providers. The LPI includes nine numeric characters and one alpha character for the service location. ZZ and PXC are the qualifiers that apply to the provider taxonomy code.
How do I fill out a CMS 1500 form for Medicare?
1:4719:58How-to Accurately Fill Out the CMS 1500 Form for Faster PaymentYouTubeStart of suggested clipEnd of suggested clipCompany in the top right hand corner of the form. Although. You may be submitting the formMoreCompany in the top right hand corner of the form. Although. You may be submitting the form electronically. The name and address of the insurance carrier must be included in this space on the form.
What is a G2 qualifier?
The G2 qualifier replaced program-specific codes, such as 1C (Medicare), to designate a proprietary identifier in all Secondary Identification provider segments. The PXC qualifier replaced the generic value of ZZ (Mutually Defined) to designate the Health Care Provider Taxonomy Code.
What is a taxonomy qualifier code?
Taxonomy codes are administrative codes set for identifying the provider type and area of specialization for health care providers. Each taxonomy code is a unique ten-character alphanumeric code that enables providers to identify their specialties at the claim level.
Which block item do you need to complete to indicate that the provider agrees to accept assignment?
ITEM 24j: RENDERING PROVIDER ID NUMBER: Required on all claims. COMMERCIAL CLAIM: Entering an X in the “YES” box indicates that the provider agrees to accept assignment under the terms of the payer's program.
What should be in box 33B on a CMS 1500?
Box 33b contains the non-NPI identity of the Billing provider. The source for the actual non-NPI value is the text entered into the field labeled 'Box 33B:' under the 'HCFA-1500/UB-92' tab of the Payers screen (of the payer to whom this claim is being sent).
What goes in box 33a on a HCFA?
National Provider Identifier numberBox 33a is used to indicate the National Provider Identifier number of the Billing Provider.
Can referring and rendering provider be the same?
o Rendering providers must be an individual provider and should be billed with the individual NPI and taxonomy. o The referring provider should not be the same as the rendering provider.
When to use CMS 1500?
When a claim involves multiple referring, ordering, or supervising physicians, use a separate CMS-1500 claim form for each ordering, referring, or supervising physician.
What is item 17?
All physicians who order services or refer Medicare beneficiaries must report this data. Similarly, if Medicare policy requires you to report a supervising physician, enter this information in item 17. When a claim involves multiple referring, ordering, or supervising physicians, use a separate CMS-1500 claim form for each ordering, referring, or supervising physician.
What is a referral physician?
Referring physician - is a physician who requests an item or service for the beneficiary for which payment may be made under the Medicare program. Ordering physician - is a physician or, when appropriate, a non-physician practitioner who orders non-physician services for the patient.
Can you use a physician's last name in a PECOS?
Enter the physician's first name and last name only. An exact match with PECOS is required. If you cannot fit the entire name in the field, use the first initial of the first name and the entire last name. Do not use a credential (e.g., "Dr." or "M.D") in the field.
Do you have to report a supervising physician on Medicare?
Enter the name of the referring or ordering physician if the service or item was ordered or referred by a physician. All physicians who order services or refer Medicare beneficiaries must report this data. Similarly, if Medicare policy requires you to report a supervising physician, enter this information in Item 17.
Is Box 17A required by Medicare?
Note: Box 17a is not required by Medicare. Be sure to verify requirements with other payers. NPI of the Referring/Ordering Physician - Enter the NPI of the referring, ordering, supervising physician or non-physician practitioner listed in item 17. All physicians and non-physician practitioners who order services or refer Medicare beneficiaries must ...
When to use CMS 1500?
Similarly, if Medicare policy requires you to report a supervising physician, enter this information in item 17. When a claim involves multiple referring, ordering, or supervising physicians, use a separate CMS-1500 claim form for each ordering, referring, or supervising physician.
Can a patient sign a claim in lieu of signing?
In lieu of signing the claim, the patient may sign a statement to be retained in the provider, physician, or supplier file in accordance with Chapter 1 , “General Billing Requirements.”. If the patient is physically or mentally unable to sign, a representative specified in chapter 1, may sign on the patient’s behalf.