CMS 1500 Box questions

Day-to-Day Users
#1

Just a few things on fee sheet updates for cms 1500 txt submissions.

I had an insurance agency ask that I put the diagnosis pointer in as an “A” instead of a “1” anyone ever have this come up as its in a section of the form that CMS lists as Optional.

also

Im seeing in that the rendering provider is showing up as the facility within version Version Number: v5.0.0 (7). Anyone have any suggestions on causes for this if we already have provider set in line item?

#2

hi @Jeremiah_Ocasio, probably easiest if you could upload some examples with any PHI removed, thank you

#3

Hello @stephenwaite,

Great here is the bottom of the 1500 txt export.

274172420 X 435-122 X 0 00 0 00 0 00
206 575-0300
Practice Name Practice Name
12700 SOUTHCENTER PARKWAY 12700 SOUTHCENTER PKWY ST
SIGNATURE ON FILE SEATTLE WA 98188 SEATTLE WA 98188
03 12 18 1902062706 1902062706

Its showing the medical practice information twice instead of the provider data in the end of the form.

#4

hi @Jeremiah_Ocasio, it’s pretty common to have 2 facilities at the bottom of the hcfa, one for service facility and the other is the billing facility. Do you know the box and field that’s in error (like 32) or the reject message? thank you

#5

Hello @stephenwaite,
The file isnt rejected but the insurance agencies are delaying payout due to the box 33 provider section showing the facility name instead. They delay till end of payment deadline then send a letter asking for who to make the payment out to for some reason. This just seems to be happening with Regence currently.

Thanks

#6

Hi @Jeremiah_Ocasio, is the ein in box 25 correct? It’s always for the billing group that usually is paid.

But this payer wants to see the rendering provider’s name in box 33?

#7

Hi @stephenwaite The rendering provider code is showing as the facility in both 32 and 33 for some reason on these. Not sure what that is caused by in the old config but for a temporary workaround I put in a facility with Dr information and use that to print as the billing facility till I have time to look at it in depth. The workaround has gotten auto approval upon electronic submission right now just to let you know.