Medisoft CMS-1500 form
CMS 1500 Report Changes with Medisoft 16
The information in this topic lists the logic from the Medisoft custom report designer used to build the CMS 1500 reports. Before modifying a CMS 1500 report, consider reviewing this topic and the topic for a better overall understanding of where data is now pulled.
Box 17a Qualifier Field
Case/Referring Provider/Pins.Legacy Qualifier 1
Box 17a Pin Field
Case/Referring Provider/Pins.Legacy 1
Box 17b NPI
Case/Referring Provider/Pins.NPI
Box 24I Qualifier field
Transaction/Attending Provider/Pins.Legacy Qualifier 1
Box 24J Pin Field
Transaction/Attending Provider/Pins.Legacy 1
Box 24J NPI Field
Transaction/Attending Provider/Pins.NPI
Box 25 Tax ID/SSN
If Claim/Provider/Pins.Tax Id = “” then print Claim/Provider/Pins.SSN Else Print Claim/Provider/Pins.Tax ID
Box 25 SSN Flag
If Claim/Provider/Pins.Tax ID = “” and If Claim/Provider/Pins.SSN <> “” then print “X”
Box 25 Tax ID Flag
If Claim/Provider/Pins.Tax ID <> “” then print “X”
Box 32a NPI
If Transaction/Facility.Name <> “” then print Transaction/Facility/Pins.NPI
If Case/Facility.Name <> “” then print Case/Facility/Pins.NPI
Box 32b Qualifier Field
If Transaction/Facility.Name <> “” then print Transaction/Facility/Pins.Legacy Qualifier 1
If Case/Facility.Name <> “” then print Case/Facility/Pins.Legacy Qualifier 1
Box 32b Pin Field
If Transaction/Facility.Name <> “” then print Transaction/Facility/Pins.Legacy 1
If Case/Facility.Name <> “” then print Case/Facility/Pins.Legacy 1
Box 33 Name Field
If Claim/Provider/Pins.Provider Claim Type = “2” then print Practice.Practice Name Else print
Claim/Provider.CMS Full Name
Box 33a NPI
If Claim/Provider/Pins.Provider Claim Type = “2” then print Practice/Pins.NPI Else print Claim/Provider/Pins.NPI
Box 33b Qualifier Field
If Claim/Provider/Pins.Provider Claim Type = “2” then print Practice Pins.Legacy Qualifier 1 Else print
Claim/Provider/Pins.Legacy Qualifier 1
Box 33b Pin Field
If Claim/Provider/Pins.Provider Claim Type = “2” then print Practice/Pins.Legacy 1 Else print
Claim/Provider/Pins.Legacy 1
CMS-1500 form
Effective May 23, 2007, NPI is the standard identifier for health care providers to use when filing and processing health care claims and other transactions.
The new "red" CMS-1500 vs the old HCFA-1500 forms:
* CMS-1500 replaces the HCFA-1500 forms
* CMS-1500 has eight new fields, four for the new NPI numbers, and four for the legacy PINs
Medisoft versions that support NPI and the new CMS-1500 forms:
* Medisoft 11 Service Pack 3
* Medisoft 12 and newer (version 14, 15, etc)
* Click here for Medisoft Service Packs
CMS-1500 box field descriptons and how they relate to Medisoft fields:
Box 17a - Referring Physican ID, or UPIN
* If Medicare is the primary coverage and there is an inside lab provider, the inside lab attending provider's UPIN is printed in this box. This information comes from the
Referring Provider edit window, PINs and IDs tab, UPIN field.
Box 17b - Referring Phycian National Provider ID
* This information comes from the Referring Provider window, National Provider ID field.
Box 24j - Legacy code for attending provider
* The top part of the box comes from the Transaction, Attending Provider, PIN. If the PIN is blank, it prints the UPIN.
* The bottom part of the box comes from the Transaction, Attending Provider, NPI.
Box 32a - Comes from the Case or Transactions, Facility, NPI
Box 32b - Comes from the Case or Transactions, Facility, NPI Qualifier, and the NPI (legacy code with qualifier)
Box 33a - Comes from the Claim, Provider, National Provider ID
* If you have a Class, it will get the NPI number from the Class
Box 33b - Legacy Code
* Comes from Claim, Provider, PIN Qualifier, followed by the Claim, Provider, PIN.
"Access Violation" after upgrading to a version of Medisoft that supports the new CMS-1500 and NPI fields:
* Result of your practice containing data that is not compatable with the new CMS-1500
* Must be manually corrected
* Run the CMS Invalid Character utility - correct what it finds