For Healthcare Providers:

First Pass Success

Submitting claims with complete information will help us reprice your claims on their "first pass", without pends or rejects.

It is especially important that you include the group number and payer name on each claim so that discounts will be applied correctly and claims can be forwarded to the correct payer.

Also, be sure to include National Provider Identifier (NPI) numbers. Claims without NPI numbers as required by CMS will be returned to you for completion and resubmission.

For additional information about completing claim forms, refer to the examples below. Contact our EDI Specialist regarding corresponding fields for electronic claims.

For Claim Form Type: Be Sure to Complete These Fields:

1500 v. 02-12:
Solo Practitioners
Group Practices

  • Box 11, Group Number
  • Box 11c, Employer/group name
  • Box 17, Name of Referring Provider
  • Box 17b, Referring Provider's NPI, required if the billing provider is a solo practitioner
  • Box 24b,POS Code
  • Box 24j, Rendering Provider's NPI, required if the billing provider is a group practice
  • Box 25, Rendering Provider's Tax ID (TIN)
  • Box 31, Signature of Physician
  • Box 32, Service Facility Name, Address, Phone Number; include if these are different from those reported in Boxes 33 and 33a
  • Box 32a, Service Facility's NPI
  • Box 33, Billing Provider's Name, Address, Phone Number
  • Box 33a, Billing Provider's NPI
  • Box 1, Billing Provider's Name and Address
  • Box 5, Federal Tax ID Number
  • Box 50a, Payer Name
  • Box 56, Billing Provider's NPI
  • Box 61, Group Name
  • Box 62, Group Number
  • Box 76, Attending Physician's NPI and Name
  • Box 77, Operating Physician's NPI and Name
  • Boxes 78-79, Other Physicians' NPIs and Names