Friday, July 29, 2016

Filling Up BOX 31 -33 in CMS 1500 FORM FOR ASC billing

Box 31 Signature of Physician or Supplier Including Degrees or Credentials Required Each claim must bear the signature of the enrolled provider or the signature of a registered authorized agent.

A holographic signature stamp may be used if authorization for the stamp is on file with the fiscal agent.
An authorized agent or representative may sign the claim for the enrolled provider if the name and signature of the agent is on file with the fiscal agent.
Each claim must have the date the enrolled provider or registed authorized agent signed the claim form. Enter the date the claim was signed using two digits for the month, two digits for the date and two digits for the year. Example: 070114 for July 1, 2014.
Unacceptable signature alternatives:
Claim preparation personnel may not sign the enrolled provider’s name.
Initials are not acceptable as a signature.
Typed or computer printed names are not acceptable as a signature.

“Signature on file” notation is not acceptable in place of an authorized signature.

32 32- Service Facility Location Information 

32a- NPI Number

32b- Other ID # Not Required

33- Billing Provider Info & Phone #
33a- NPI Number
33b- Other ID #

Enter the name of the individual or organization that will receive payment for the billed services in the following format:
1st Line
2nd Line
3rd Line
City, State and ZIP Code
33a- NPI Number
Enter the NPI of the billing provider
33b- Other ID #

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