This chapter is extremely useful when you find an error on your scoring report that you want to locate in ClaimGear and correct.

Below is an example of the CMS-1500 claim form. The box numbers referred to on the scoring report and on the Specs are also on the box numbers on the CMS-1500 claim form.
CLAIMGEAR CMS-1500 SPECS |
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BOX DESCRIPTION OF FIELD ON FORM AND IN CLAIMGEAR |
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LOCATION OF FIELD IN CLAIMGEAR |
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1 |
1 |
Payer/Carrier
Type |
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Payer -F6 tab, Find or Add, Payer Type |
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a |
Insured's ID Number |
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*Patient -F2 tab, Search or Add, 2 Insured tab, Payers tab, Set Payer 1, enter Member Id# |
2 |
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Patient's last name, first name, and middle initial |
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Patient -F2 tab, 1 Patient tab, enter Last Name, First, MI |
3 |
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Patient's Date of Birth |
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Patient -F2 tab, 1 Patient tab, enter Birth date |
4 |
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Enter the Insured's last name, first name, and middle initial |
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Patient -F2 tab, 2 Insured tab, enter Last Name, First, MI |
5 |
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Patient's Address |
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*Patient -F2 tab, 1 Patient tab, enter Address |
6 |
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Patient Relationship to Insured |
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*Patient -F2 tab, 2 Insured tab, enter Patient Relationship to the Insured? |
7 |
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Insured's Address |
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*Patient -F2 tab, 2 Insured tab, enter Address |
8 |
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Patient Status: Single, Married, Other, Employed, Full-Time Student, Part-Time Student |
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Patient -F2 tab, 1 Patient tab, Defaults tab, enter Marital Status or Student Status or Employed Status |
9 |
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Other Insured's Name (Last, First, MI). 2 ways: |
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*1) Patient -F2 tab, 2 Insured tab, enter Last Name, First, MI |
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*2) Patient -F2 tab, 3 Other Insured tab, enter Last Name, First, MI |
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9a |
Other Insured's Policy AND Group number |
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*1) Patient -F2 tab, 2 Insured tab, Payers tab, Payer 2, enter Group Number AND Member ID# |
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*2) Patient -F2 tab, 3 Other Insured tab, Payer 3, enter Group Number AND Member ID# |
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9b |
Other Insured's Date of Birth |
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*1) Patient -F2 tab, 2 Insured tab, enter Birth date |
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*2) Patient -F2 tab, 3 Other Insured tab, enter Birth date |
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9c |
Other Insured's Employer's Name |
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*1) Patient -F2 tab, 2 Insured tab, Employer tab, enter Employer Name |
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*2) Patient -F2 tab, 3 Other Insured tab, enter Employer Name |
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9d |
Insurance Plan Name |
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*1) Patient -F2 tab, 2 Insured tab, Payers tab, Payer 2, enter Payer 2 by 'New Payer' or 'Find Payer' |
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*2) Patient -F2 tab, 3 Other Insured tab, Payer 3, enter Payer 3 by 'New Payer' or 'Find Payer' |
10 |
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Patient's Condition; Type of Accident |
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1) Claim -F1 tab, 3 Additional Info tab, enter Yes for specific accident type (10b requires state abbreviation) |
11 |
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Insured's Policy Group Number |
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*Patient -F2 tab, 2 Insured tab, Payers tab, Payer 1, enter Group Number |
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11a |
Insured's Date of Birth |
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*Patient -F2 tab, 2 Insured tab, enter Birth date |
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11b |
Enter the Employer's name |
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*Patient -F2 tab, 2 Insured tab, Employer tab, enter Employer Name |
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11c |
Insurance Plan Name |
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*Patient -F2 tab, 2 Insured tab, Payers tab, enter Payer 1 by 'New Payer' or 'Find Payer' button |
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11d |
Is there another health benefit plan? |
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System defaults this information. If wrong, see Box 9 and complete correctly. |
12 |
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Patient's or Auth Signature |
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*Patient -F2 tab, 2 Insured tab, enter 'Signed signature authorization form for both Block 12 and 13 are on file' |
13 |
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Insured's or Auth Signature |
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*Patient -F2 tab, 2 Insured tab, enter 'Signed signature authorization form for both Block 12 and 13 are on file' |
14 |
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Date of Current Illness/Injury/Pregnancy |
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1) Claim -F1 tab, 3 Additional Info tab, enter Date of Onset of Illness or Accident or LMP |
15 |
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Date of Same or Similar Illness |
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Claim -F1 tab, 3 Additional Info tab, enter Date of Similar Illness |
16 |
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Dates Patient Unable to Work in Current Occupation |
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Claim -F1 tab, 3 Additional Info tab, enter Unable to Work From Date and To Date |
17 |
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Name of Referring Physician |
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b |
Referring Physician NPI |
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1) Claim -F1 tab, 1 Claim tab, enter Select Referring/PCP Provider |
18 |
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Hospitalization Dates Related to Current Services |
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Claim -F1 tab, 3 Additional Info tab, enter Hospitalized From Date and To Date |
19 |
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Reserved For Local Use |
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Not applicable |
20 |
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Outside Lab and Charges |
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Claim -F1 tab, 3 Additional Info tab, enter Lab Charges |
21 |
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Diagnosis |
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Claim -F1 tab, 2 Charges tab, enter ICD# |
22 |
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Medicaid Resubmission Code |
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Claim -F1 tab, 3 Additional Info tab, enter Resubmit Reason Code |
23 |
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Prior Authorization Number |
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Claim -F1 tab, 1 Claim tab, enter Authorization # and press 'Copy Authorization to Claim' button |
24 |
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Charges |
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a-g |
Claim -F1 tab, 2 Charges tab, enter Information |
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24a |
Dates of Services - From and To Date |
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24b |
Place of Service (POS) |
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24d |
Procedure code (CPT) |
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24f |
Total Charges |
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24g |
Units |
24 |
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Rendering ID Qualifier |
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i |
Automatically populate based on payer information |
24 |
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Non-NPI number |
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j |
Payer- F6 tab, Select Payer, Provider ID Numbers tab, enter Individual number |
24 |
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NPI Number |
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j |
Claim F -1 tab, 1 Claim tab, and Select Rendering Provider and Select Billing Provider |
24 |
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Payment Information - InsPay InsAdj InsAllow |
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x |
Payment -F3 tab, 3 EOB Posting tab, Find, Search, Select Patient, |
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correct insurance payment, adjustment, or allowed |
25 |
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Federal Tax ID Number |
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Claim F -1 tab, 1 Claim tab, and Select Rendering Provider and Select Billing Provider |
26 |
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Patient's Account No. |
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Automatically generated by ClaimGear |
27 |
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Accept Assignment? |
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*Patient -F2 tab, 2 Insured tab, enter 'Yes, The provider accepts the assignment of benefits' |
28 |
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Total Charge |
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Claim -F1 tab, 2 Charges tab, enter Total Charges (= Unit Price X Units) |
29 |
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Amount Paid |
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Payment -F3, enter 1 Line Item Posting (co-pay) OR 3 EOB Posting (Insurance payment) tab |
30 |
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Balance Due |
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Claim -F1 tab, 2 Charges tab, enter Information [= Adjustments + Money Due (by Patient or Insurance)] |
31 |
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Signature Of Physician or Supplier |
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Claim -F1 tab, 1 Claim tab, and Select Rendering Provider and Select Billing Provider |
32 |
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Name and Address of Facility |
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Claim -F1 tab, 1 Claim tab, enter Select Facility |
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a |
Facility NPI |
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Claim -F1 tab, 1 Claim tab, enter Select Facility |
33 |
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Physicians or Suppliers Billing Information |
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Claim -F1 tab, 1 Claim tab, enter Billing Provider |
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a |
Billing NPI |
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Claim -F1 tab, 1 Claim tab, enter Billing Provider |
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b |
Billing Other ID |
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Claim -F1 tab, 1 Claim tab, enter Billing Provider |
* |
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Information on the Patient -F2 tab, 1 Insured tab OR 2 Other Insured tab |
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If any information on these two screens have been changed after its initial entry, |
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update the information and go to 4 Misc. Info tab, check B, and click Save. |
NA |
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Claim - Not Found |
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One or more are incorrect, fix and rescore. Patient Name (box 2), DOB (box 3), and DOS (box 24a). |
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See page 71 of this manual for a detailed description. |
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NA |
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Charge – Not Found |
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1 or more are incorrect, fix and rescore. DOS (box 24a) and Charges (24d). |
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See page 70 of this manual for a detailed description. |