When creating a claim form, you may want to auto-populate more fields than just the standard demographic, insurance, appointment, and provider information.
SimplePractice can automatically fill out the following additional fields on the CMS 1500 (HCFA) form:
- Box 9. A CLIENT'S SECONDARY INSURANCE INFORMATION
- Box 10. IS PATIENT'S CONDITION RELATED TO
- Box 14. DATE OF CURRENT ILLNESS, INJURY, or PREGNANCY (LMP)
- Box 16. DATES PATIENT UNABLE TO WORK IN CURRENT OCCUPATION
- Box 17, 17a, 17b. NAME OF REFERRING PROVIDER OR OTHER SOURCE
- Box 18. HOSPITALIZATION DATES RELATED TO CURRENT SERVICES
- Box 20. OUTSIDE LAB and LAB CHARGES
- Box 23. PRIOR AUTHORIZATION NUMBER
- Box 26. PATIENT'S ACCOUNT NUMBER
- Box 27. ACCEPT ASSIGNMENT?
Note: See How do I use Authorization Tracking? to learn more about Authorization Tracking and adding a prior authorization number to claim forms.
How to enable additional fields on the CMS 1500 form
Here's how to enable additional fields:
- Navigate to a client's Overview page and click Edit details
- Click the Billing and Insurance tab
- Select Show additional claim fields in the Insurance Claim/CMS Fields section
- Complete the fields you want to populate onto your claim forms
Note: If you'd like these fields to auto-populate on claims for all your clients, you can enable these additional fields for each client you create.
For client's with a secondary insurance on file, there will be an option available to Include secondary insurance info on primary claim? The necessity of this information depends on each insurance company as each insurance company adjudicates their claims differently in their system. It could be possible that some insurance companies do not require this information while others do.
Note: The Include secondary insurance info on primary claim? option will only be present if you have already saved the primary and secondary insurance information in the client's profile.
From then on, every primary claim you create will include the secondary insurance information in box 9 of your primary claim.