Instructions:
The following case study is for patient Coleman Parker. Complete the CMS-1500 claim form for this patient who has both group insurance through his wife's employer and Medicare. This will provide you an opportunity to work through the process of submitting a CMS claim form when there is more than 1 insurance provider.
Assignment:
1. Review the following documents:
2. Open and complete the following document: CMS - 1500 claim form (PDF Download).
You will need to find the allowable charge. Go to this website and do some research: Physician Fee Schedule Lookup (Webpage). You will need to find the allowable charge.
Use 42 17890908 EIN for Block 25.
The date in Block 31 should be 1 day after the last day of service listed on the claim.
Use X100X1000 as the facility NPI for Block 33a.
3. Submit the completed document following these steps:
NOTE: If you do not follow these steps exactly, your form will not save the information that you have embedded into it.