How to bill a CMS-1500 for nurse case management

The boxes that matter most

• Box 1a: the insured's ID number. Many auto and workers' compensation payers want the claim number here or in Box 11b (with the qualifier Y4); check what each payer asks for.
• Boxes 2, 3 and 5: the patient's name, date of birth, sex and address.
• Box 10a–c: whether the condition is related to employment, an auto accident (with the state) or another accident.
• Box 14: the date of the injury.
• Box 21: the ICD-10 diagnosis codes.
• Box 24A–G: one line per service: dates, place of service, CPT/HCPCS code and modifiers, diagnosis pointer, charge and units.
• Boxes 24J and 33a: the rendering and billing provider NPI.
• Box 25: your Federal Tax ID (EIN).
• Box 33: your billing name, address and phone. Box 33b is commonly used for your taxonomy code with the ZZ qualifier.

Avoid the common rejections

• Check the claim number and adjuster with the carrier before the first bill.
• Use the NPI and Tax ID exactly as they're registered.
• Make each line's charge equal its units times your rate, and the total equal the lines.
• Bill mileage the way your payer asks: as its own line or on the same claim.
• Keep the activity log or notes that support each line; payers often ask for them.

How CaseMgmt fills it in

Your Tax ID, NPI, taxonomy and default place of service are saved once in Company Settings and fill in on every claim. Batches are built from billable case notes, so dates, units and charges come straight from the work. You can change any box in the CMS-1500 editor before you download, email or fax the claim, and optionally put the auto claim number in Box 1a automatically.