Recent Updates
-
Updated on: Dec 07, 2022
Service Facility NPI
Manual CMS 1500 (08/05) Crosswalk -
Updated on: Dec 07, 2022
Service Facility Location Information
Manual CMS 1500 (08/05) Crosswalk -
Updated on: Dec 07, 2022
Signature of Physician
Manual CMS 1500 (08/05) Crosswalk -
Updated on: Dec 07, 2022
Balance Due
Manual CMS 1500 (08/05) Crosswalk -
Updated on: Dec 07, 2022
Amount Paid
Manual CMS 1500 (08/05) Crosswalk -
Updated on: Dec 07, 2022
Total Charge
Manual CMS 1500 (08/05) Crosswalk -
Updated on: Dec 07, 2022
Accept Assignment
Manual CMS 1500 (08/05) Crosswalk -
Updated on: Dec 07, 2022
Patient Account Number
Manual CMS 1500 (08/05) Crosswalk -
Updated on: Dec 07, 2022
Federal Tax I.D. Number
This Federal Tax I.D. number will be placed in Box 25 of the CMS 1500 form.
Manual CMS 1500 (08/05) Crosswalk -
Updated on: Dec 07, 2022
Rendering Provider NPI
This Rendering Provider ID will be placed in the shaded pink portion of the charge, in box 24J of the claim.
Manual CMS 1500 (08/05) Crosswalk