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
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.