Overview
The CMS-1500 (formerly HCFA-1500) is the standard claim form used for billing professional services. This guide maps each box on the form to its corresponding location in Elation Billing.Visual Guide
Click the image to expand it:
Field Reference Table
| Box # | Title | Location in Elation Billing |
|---|---|---|
| 1 | Insurance Type, Insured’s ID | Insurance Coverage |
| 1a | Insured’s ID Number | Insurance Coverage |
| 2 | Patient’s Name | Patient Demographics |
| 3 | Patient’s Birth Date | Patient Demographics |
| 4 | Insured’s Name | Insurance Coverage → See More |
| 5 | Patient Address | Patient Demographics |
| 6 | Patient Relationship to Insured | Insurance Coverage → See More |
| 7 | Insured’s Address, Telephone | Patient Demographics |
| 9 | Other Insured’s Name | Secondary Insurance |
| 9a | Other Insured’s Policy/Group Number | Secondary Insurance |
| 9d | Other Insurance Plan Name | Secondary Insurance |
| 10 | Condition Related To | Superbill → More Fields |
| 11 | Insured’s Policy Group | Insurance Coverage |
| 12 | Information Release Signature | Signature on File |
| 13 | Payment Authorization Signature | Signature on File |
| 14 | Date of Illness/Injury/Pregnancy | Superbill → More Fields |
| 17 | Referring Provider Name | Superbill → Add Referring |
| 17a | Non-NPI ID | Superbill → More Fields |
| 17b | Referring NPI | NPI on File |
| 19 | Additional Claim Information | Superbill → Claim Narrative |
| 21 | Diagnoses Codes | Claim Lines (aggregated) |
| 22 | Resubmission/Frequency Code | Superbill → Corrected Claim Info |
| 23 | Prior Authorization Number | Superbill → + Add Authorization |
| 24a | DOS | Claim Line(s) |
| 24b | POS | Location |
| 24d | CPTs, Modifiers | Claim Line(s) |
| 24e | DX Pointer | Claim Line(s) |
| 24f | Charges | Claim Line(s) |
| 24g | Days/Units | Claim Line(s) |
| 24h | EPSDT Family Plan | Charge Line Note or More Fields |
| 24i, 24j | Rendering Provider ID | Practice Settings → Providers |
| 25 | Federal Tax ID Number | Practice Settings → Practice Info |
| 26 | Patient’s Account Number | Superbill ID + Practice indicator |
| 27 | Accept Assignment | Superbill → More Fields → Box 27 |
| 28 | Total Charge | Total of Charges |
| 29 | Amount Paid | Pulled from previous Payments |
| 31 | Signature of Physician | Name of Rendering, Date Submitted |
| 32 | Service Facility Location | Practice Settings → Service Locations |
| 33 | Billing Provider Info | Practice Settings → Practice Info |