OfficeMate Home Office User's Guide - OfficeMate Software Solutions

Chapter 11 Processing Insurance Claims
Processing CMS 1500 Claims
For a visual
representation of
how the CMS 1500
form is populated
in OfficeMate, go
to
http://www.office
mate.net/pdfs/cm
s1500_Form.pdf.
Note,
cont.
• Box 11A: Patient Center window > Demographics button
> Insurance tab > Detail button > Insured Party Sex
(Box 11a) radio button and DOB (Box 11a) text box (if
Other or Guarantor is selected as the insured party)
Medicare: Blank if the Insured Party and Patient are the same.
Other Insurances: Box A populates if the Insured Party and the
Patient are different.
• Box 11B: Patient Center window > Demographics button
> Insurance tab > Detail button > Insured Party
Employer (Box 11b) drop-down menu (if Other or
Guarantor is selected as the insured party)
Medicare: Blank if the Insured Party and Patient are the same.
Other Insurances: Box B populates if the Insured Party and the
Patient are the same and if an employer is recorded.
• Box 11C: Patient Center window > Demographics button
> Insurance tab > Detail button > Plan Name (Box 11c)
drop-down menu (if Other or Guarantor is selected as the
insured party)
Medicare: Blank if the Insured Party and Patient are the same.
Other Insurances: Box C populates if the Insured Party and the
Patient are different.
To maintain insurance plans: Setup > Insurance Setup >
Plan tab
• Box 11D: The default is NO, but it is automatically changed to
YES if there is another insurance carrier selected in box 9D.
• Box 12: Patient Center window > Demographics
button > Insurance tab > Detail button > Signature On
File check box
• Box 13: Patient Center window > Demographics
button > Insurance tab > Detail button > Signature On
File check box. If the guarantor is not a patient, NO
SIGNATURE ON FILE will be displayed in box 13. You can
edit this box if necessary.
• Box 14, Box 15, & Box 16: Edit directly on the CMS 1500
form.
• Box 17: Patient Center window > Demographics button >
select Professional from the Referred By radio buttons and
click the Referred Name button to select a referring provider
The referring provider only populates if the preference is set to
Yes by for the insurance carrier: Setup > Insurance Setup >
Insurance Carrier tab > Claim Form tab > Box 17
Populate radio button
Or, edit directly on the CMS 1500 form.
To maintain referring providers: Setup > Resource Setup >
Referring Dr tab
OfficeMate Home Office User’s Guide 437