How Elation Billing Corresponds to the HCFA 1500 - Elation Help Center

This article provides a reference guide showing how Elation Billing fields correspond to the HCFA/CMS 1500 claim form boxes.

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:

Annotated Elation Billing superbill screen with numbered callouts mapping UI fields to HCFA 1500 boxes, including Insurance Coverage (1, 1a), patient demographics (2-5, 7), secondary insurance (9, 9a, 9d), claim lines (21, 24a-g), rendering provider (24i-j), location (24b), authorization (23), and toolbar buttons for Corrected Claim Info (22), Claim Narrative (19), and More Fields (10, 14, 17, 25, 27, 33).

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
18	Hospitalization Dates (Admit Date only)	Superbill → Location Code 21, 22, or 31
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

Box 18 only supports an Admit Date. The Discharge Date field in Box 18 is not supported by Elation Billing at this time.

Exception: If a payer has a Special Payer Rule configured (Practice Settings → Insurance → the payer’s NPI/Tax ID rules), that rule’s NPI overrides the entity’s default NPI in Box 33 for claims to that payer. See Practice Settings Setup and Overview to review or update Special Payer Rules.

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