CMS-1500 Box

Field Description

Source in Aloha

Notes

1

Insurance Type

Payer Profile

1a

Insured's ID Number

Client Profile → Authorization Tab → Client's Payer Card

The insured ID is located on the client's payer card.

2

Patient Name

Client Profile

Client's first and last name.

3

Patient Date of Birth / Gender

Client Profile

Date of birth and gender recorded on the client profile.

4

Insured's Name

Client Profile → Authorization Tab → Client's Payer Card

To add or update the insured's name, first add the individual in the Client Contacts section. After saving, refresh the page and navigate to the client's payer card. The insured's name will then be available for selection in the Insured Name dropdown.

11a

Insured's Date of Birth/ Gender

Client Profile → Authorization Tab → Client's Payer Card

Pulls the insured's date of birth and gender from the client's payer card.

11

Insured's Policy Group Number

Client Profile → Authorization Tab → Client's Payer Card

Located on the client's payer card under Group Number.

21

Diagnosis Codes

Client Authorization

Diagnosis codes automatically pull from the payer services. Additional diagnosis codes can be added under the client's authorization.

23

Authorization Number

Client Authorization

Pulls the authorization number from the client's authorization.

24A

Date(s) of Service

Appointment

Pulls the service date from the appointment.

24B

Place of Service

Client Authorization / Appointment / Billing Manager

The Place of Service (POS) code can be defaulted in the client's authorization, updated when scheduling the appointment, or bulk updated in the Billing Manager.

24D

Procedure Code and Modifiers

Payer Services / Billing Rules

Pulls the CPT code and applicable modifiers configured for the service.

24F

Charges

Payer Services

Calculated using the service charge rate multiplied by the billed units.

24G

Units

Appointment Duration

Calculated based on the appointment duration and payer service billing rules.

24J

Render Provider Number

Billing → Provider Identifier

Pulls the rendering provider's NPI and taxonomy from the Provider Identifier section.

25

Federal Tax ID Number

Organization

Pulls the EIN or Tax ID associated with the billing organization.

31

Rendering Provider

Billing → Provider Identifier / Payer Billing Rules / Client Authorization

Rendering providers are configured under Billing > Provider Identifier. If the rendering provider is the BCBA supervising the case, it can be defaulted in the client's authorization. If the rendering provider is the staff member who provided the service, this is configured under Payer > Billing Rules > Claim Settings.

32

Service Facility Location

Organization / Billing → Provider Identifier

After adding an organization address, mark the organization as the service facility in Billing > Provider Identifier. It can then be selected or defaulted within the client's authorization.

33

Billing Provider Information

Organization or Staff → Billing → Provider Identifier

After adding an organization address, designate the organization or staff member as the billing provider in Billing > Provider Identifier.