Cms 1500 Claim Filing Instructions
ADVERTISEMENT
1
2
3
4
5
6
7
8
9CMS 1500 Claim Filing Instructions
Field
Requirements
Field Description
Locator
1
Not Required
Type of health insurance coverage applicable to claim
Patient’s type of coverage.
1a
Required
Insured’s ID Number
Identification or certificate number assigned to the
insured/subscriber. Please submit complete number including
alpha prefix.
2
Required
Patient’s Name (Last, First, Middle Initial)
Patient’s last name, first name, and middle initial.
3
Required
Patient’s Birth Date, Sex
Patient’s month, day and year of birth in MM/DD/CCYY format.
Patient’s sex is identified by M (male) or F (female).
4
Required
Insured’s Name (Last Name, First Name and Middle Initial)
Subscriber’s last name, first name, and middle initial. (If same as
patient you may indicate “same”).
5
Required
Patient’s Address (No, Street)
Patient’s address. (If same as subscriber you may indicate
“same”).
6
Required
Patient Relationship to Insured
1
ADVERTISEMENT
0 votes
Related Articles
Related forms
Related Categories
Parent category: Medical