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Auto-populating additional fields on claim forms

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 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

insuranceclaimfields.simplepractice.billingandinsurance.jpg

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.

 

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