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Instructions and Guidelines for setting up the new CMS-1500 (08/05) claim form
This document applies to M.D. Complete for SQL version 2008.00x.x
For other questions, please send inquiries to http://shop.mdcomplete.com/contactus.sc
To verify the settings, or to set other specific options, select an Insurance carrier from the Insurance List and click the Edit button.
For each insurance carrier, make sure you have specified the correct type of insurance or payer. In the drop down list for Insurance Type, the options are:
Medicare
Medicaid
Champus
Champva
Group Health Plan
FECA Blk Lung
Blue Cross
Other
Private Pay
Make sure that you specify this option correctly. For most commercial payers, you need to specify Other. This selection translates to Box 1 of the CMS-1500 form.
For each provider listed, enter the appropriate PIN numbers. These numbers are typically shown in Box 33 of the older 12/90 form. If you are using the new 08/05 form, these numbers may be required as secondary identification numbers for box 33b and the shaded portion of box 24j.
Click the Filing Setup tab to specify the type of form that this payer is using.
Generally, if you are still using the old 12/90 form, then you should not be specifying NPI numbers for any of the data fields.
The selection box for Use HCFA Form should be set to ‘CMS-1500 08/05’
Box 23. If this payer requires information to be displayed in Box 23, enter the appropriate selection. The options are:
None
Show Practice CLIA (File Menu - Practice Information)
Show Patient Precertification Number (Patient Demo - Notes Tab)
When you create a claim, the data for box 23 will be automatically shown in the box labeled PRIOR AUTHORIZATION number. This field can be edited as claims are created. The data can be removed if needed or added if needed.
Box 33 Name and Address. Select the Name/Address that you want displayed in Box 33
Options are:
None
Practice Name/Address – File Menu – Practice Info
Physician Name/Address – Rendering Physician from Claim Entry Screen
Facility Name/Address – Facility from Claim Entry Screen (*see note below for box 32)
Box 24j (Service Line identifier). For Medicare, or if the payer requires the rendering provider NPI, select Show Rendering Provider NPI. This NPI is entered in the Physicians Edit screen. Physicians List – Edit button. Enter the physician NPI in the ‘National Provider ID’ field.
Box 33a Primary Identifier. Select either the Rendering Provider NPI, Billing Provider NPI, or Facility NPI.
The rendering provider NPI is entered in the Physicians Edit screen. Physicians List – Edit button. Enter the physician NPI in the ‘NPI’ field.
The billing provider NPI is entered in the Practice Information screen. File Menu – Practice Information. Enter the billing NPI in the field that says ‘Billing Provider NPI’.
The Facility NPI is entered in the Facility Edit Screen.
Secondary Identifiers. The secondary identifier selection will determine the data in box 33b as well as the shaded area in box 24J. For Medicare and Medicaid, you will typically select Provider Legacy Pin number for Box 24J (shaded) and Billing Legacy Group number for box 33B.
For box 24j, the rendering provider legacy pin number is entered. This data comes from the Insurance Carrier screen Information tab. At the bottom next to each physicians’ name is where the legacy provider pin number is entered.
For box 33b, the billing provider legacy pin number is entered. This data comes from the Insurance Carrier screen. At the bottom next to each provider, enter the number in the field that say ‘Provider Group’.
If the Box 33 name/address is selected to use the Facility Name, then the Facility secondary ID number is shown in box 33b. The Facility secondary ID number is entered in the Facility Edit Screen.
For box 24J shaded and box 33B, a qualifier will be printed next to each ID number. The following qualifiers are used
1B Blue Cross
1C Medicare
1D Medicaid
G2 Other
0B State License number
1G Physician UPIN number
Setting up Box 32 (Facility or Hospital)
Box 32 will contain the Facility Name that is selected when you create a claim.
Box 32A and 32B will receive the ID numbers associated with the selected Facility or Hospital. If a secondary ID number is used for box 32B, a ‘1C’ qualifier is automatically placed in front of the secondary id number.
* note Another option for Box 32 is to show the Patient Name/Address in box 32 when the place of service code is set to 12. If you use this option, make sure that you are not using the facility name for box 33. Otherwise that Patient name/address will appear in box 33.
You can specify a particular facility to be the default facility when you create claims. Edit the Facility and check the box that says 'This Facility is where most services are performed'. When you have a default facility, then the claim screen will automatically select this facility when you create claims.
Setting up Box 17 (Referring Physician)
Box 17 will print the referring physician if a referring physician was selected when creating a claim.
Box 17a will print the referring physician UPIN number with a ‘1G’ qualifier.
Box 17b will print the referring physician NPI number. This NPI is entered in the Physicians Edit screen. Physicians List – Edit button. Enter the physician NPI in the ‘NPI’ field.
To align your form, select the Edit Menu – Preferences - HCFA Settings. Enter the Horizontal and Vertical Nudge Parameters to move the form up/down or left/right.
Horizontal Nudging
Enter a positive number to move the text to the right.
Enter a negative number to move the text to the left.
Vertical Nudging
Enter a positive number to move the text down
Enter a negative number to move the text up.
You can darken the font by changing the font weight parameter. For CMS-1500 08/05, the font size and font type cannot be changed.
When using the Test button from the Edit – Preferences screen, make sure you click the Apply button after you enter new nudge parameters. Then click the Test button.
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