How do I apply an adjustment to a patient's account? Then click Insured's / Other Insured's Information. 'Duplicate claim within 90 days': Why am I seeing this rejection. More information is available in the 'Print Claims' section of . To access the information in these boxes, go to Front Desk > Patient Mgmt > Pat. Claims for IHS and Tribally . There are several ways to apply charges to the patients account: There are 2 different 24j fields on the claim form: 24j and what we refer to as 24jNPI. How do I edit Box 25 on the HCFA 1500 form to show 'Other' Tax ID and/or SSN? Clean claim resubmissions must be received no later than 12 months from the date of services or 12 months after the date of eligibility posting, whichever is later. How do I apply charges to a self-pay or cash-pay account? Then select the Condition tab. This document is to be used as a map that will show you where to input the information as it populates on your 1500 HCFA Claim Form. Download the free version of Adobe Reader. Dialysis clinics, nursing homes, free-standing birthing centers, residential treatment centers, and hospice services also are billed on the UB-04 claim form. Simplify complex processes with our Service Center. Located across the US, our expert team is always available to support you. Book a one-on-one call with a ChiroTouch Specialist to see how ChiroTouch can help your practice. 1) Open any claim in DentalWriter, and click the "print" button located at the top of the claim form, shown below: 2) The printing options will will appear. Please contact your clearinghouse before changing any of these settings, in order to confirm the need and the process. FQHC services may also be billed on a CMS 1500 claim form. Info. Organize patient scheduling and manage the billing for your practice. How do I re-print a HCFA 1500 claim form? hcfa 1500 image CMS-1500 form instructions - U.S. Career Institute Please click an image to enlarge it. Selecting the option "