Medicare Claims Processing Manual Crosswalk

Medicare Claims Processing Manual Chapter 25 - Completing and Processing the Form CMS-1450 Data Set Table of Contents (Rev. 10880, 08-06-21) Transmittals for Chapter 25 10 - Reserved 70 - Uniform Bill - Form CMS-1450 - Uniform Billing with Form CMS-1450 - Disposition of Copies of Completed Forms 75 - General Instructions for Completion of Form CMS-1450 for Billing - Form Locators 1-15 - Form Locators 16-30 - Form Locators 31-41 - Form Locator 42 - Form Locators43-65 Form Locators 66-81 80 - Reserved 10 - Reserved 70 - Uniform Bill - Form CMS-1450 (Rev. 2874, Issued: 02-06-14, Effective: 03-07-14, Implementation: 03-07-14) - Uniform Billing with Form CMS-1450 (Rev. 2922, Issued: 04-03-14, Effective: 04-18-14, Implementation: 04-18-14) This form, also known as the UB-04, is a uniform institutional provider bill suitable for use in billing multiple third party payers.

FL58 Insured's Name - Secondary B AN 25 1 FL58 Insured's Name -Tertiary C AN 25 1 FL59 Patient’s Relationship - Primary A AN 2 1 FL59 Patient's Relationship - Secondary B AN 2 1 FL59 Patient's Relationship - Tertiary C AN 2 1 FL60 Insured's Unique ID - Primary A AN 20

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