Recent Updates
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Updated on: Dec 07, 2022
Another Health Benefit Plan
<p>Indication for additional health plans</p>Manual CMS 1500 (08/05) Crosswalk -
Updated on: Dec 07, 2022
Insurance Plan Name or Program Name
<p>Populating the Insured's information</p>Manual CMS 1500 (08/05) Crosswalk -
Updated on: Dec 07, 2022
Employer's Name or School Name
<p>Populating the Insured's information</p>Manual CMS 1500 (08/05) Crosswalk -
Updated on: Dec 07, 2022
Insured's Date of Birth and Gender
<p>Populating the Insured's information</p>Manual CMS 1500 (08/05) Crosswalk -
Updated on: Dec 07, 2022
Insured's Policy Group or FECA Number
<p>Populating the Insured's information</p>Manual CMS 1500 (08/05) Crosswalk -
Updated on: Dec 07, 2022
Patient Condition Related To: Other Accident
<p>Indicating that the patient's condition is related to an accident. </p>Manual CMS 1500 (08/05) Crosswalk -
Updated on: Dec 07, 2022
Patient Condition Related To: Auto Accident
<p>Indicating that the patient's condition is related to an auto accident. </p>Manual CMS 1500 (08/05) Crosswalk -
Updated on: Dec 07, 2022
Patient Condition Related To: Employment
<p>Indicating that the patient's condition is employment related. </p>Manual CMS 1500 (08/05) Crosswalk -
Updated on: Dec 07, 2022
Insurance Plan Name or Program Name
<p>Populating the Other Insured's Plan Name or Program Name: If Box 11d is marked Yes, fields 9 and 9a-d will need to be completed.</p>Manual CMS 1500 (08/05) Crosswalk -
Updated on: Dec 07, 2022
Employer's Name or School Name
<p>Populating the Other Insured's Employer's Name or School Name: If Box 11d is marked Yes, fields 9 and 9a-d will need to be completed.</p>Manual CMS 1500 (08/05) Crosswalk