ABSTRACT
Unit II: Introduction to the Top Portion of the Claim Form Œe top portion of the CMS-1500 can be broken into four areas of information and each area is located in a specic box (or block):
1. Patient information: Name of the patient, patient date of birth, patient relationship to the policyholder (insured), patient address, status of patient
2. Coverage information: Type of insurance, policyholder (insured) identication (ID) number, policyholder (insured) name, policyholder (insured) address, policyholder (group number), policyholder (insured) date of birth, policyholder (insured) name of employer or school, name of the plan, policyholder (insured) signature
Di•erent Types of Claim Forms ........................................................................................................................................1 Unit II: Introduction to the Top Portion of the Claim Form .................................................................................................1
