CMS-1500 forms are typically used for claims that need to be mailed; however, payers and providers often speak in terms of the CMS-1500. For example, a payer might say, "The claim was denied because you are missing the rendering NPI in box 24J." . Claims sent electronically from Checkpoint are sent via an .837P file. The .837P file is a different format but contains the same information as the CMS-1500.
Below is an example of a CMS-1500 form.
The information on the CMS-1500 and in the .837P file are populated from certain areas in CP. Below are the most common areas with issues and where the information is found in Checkpoint.
1A. Insured's I.D. Number: Client Insurance page
2. Patient's Name: Client Details page
3. Patient's Birth Date and Sex: Client Details page
4. Insured's Name: Client Details page unless Primary Policyholder section under Client Insurance page is completed.
5. Patient's Address: Client Details page
6. Patient Relationship to Insured: Client Insurance page
11A. Insured's Date of Birth: Client Details page unless Primary Policyholder section under Client Insurance page is completed.
11C. Insurance Plan Name or Program Name: Client Insurance page
11D. Another Health Plan: Client Insurance page
21A. Diagnosis: Client Details page-> Clinical Tab-> Assessments and Diagnoses.
22. Resubmission Code and Original Ref. No.: Claim Batch Files-> Void/Replace Claim
23. Prior Authorization Number: Client Authorization
24A. Dates of Service: Client Session page
24B. Place of Service: Client Session page
24D. Procedures Code: Client Session page
24G. Charges: Client Session page
24G. Days or Units: Client Sessions page
24J. Rendering Provider ID #: Staff profile unless an exception is listed on the Office page.
25. Federal Tax I.D. Number: Agency page
31. Signature of Physician: Client Progress Note
32. Service Facility Location: Office Details page
33. Billing Provider Info: Office Details page
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