Where is the secondary insurance information placed on a cms-1500 claim form

List the primary diagnosis on Line 1 and secondary diagnosis on Line 2. Additional diagnoses are optional and may be listed on Lines 3 and 4. Required.

What goes in Box 9 of the CMS 1500 form?

What is it? Box 9 indicates that there is another policy that may cover the patient. The insured's name is entered as Last Name, First Name, Middle Initial, separated by commas. If Box 11d is marked, complete boxes 9, 9a, and 9d; otherwise, leave blank.

What is in Box 21 of the CMS 1500 claim form?

What is it? Box 21 is used to indicate the diagnosis codes for the symptom, complaint, or condition of the patient. Use lines A-L to list up to 12 diagnosis codes to the highest level of specificity.

What is Field 24 in CMS 1500 claim form?

24F Required Charges - Enter the charge for service in dollar amount format. If the item is a taxable medical supply, include the applicable state and county sales tax. 24G Required Days or Units - Enter the number of medical visits or procedures, units of anesthesia time, oxygen volume, items or units of service, etc.

When completing the CMS 1500 form which section contains information?

When completing the CMS-1500 Form, which section contains information about the patient and the insured? Both A and B; Social Security Number (SSN). Employer Identification Number (EIN).