Insurance & Authorization | Medicare Billing: CMS-1500 & 837P

Loop 2000B SBR09 / Item 1

Table 20: Loop 2000B SBR09 / Item 1 Fields
Health Insurance	Source
To show the type of health insurance coverage applicable to this claim, check the Medicare box on the CMS-1500. Use value MB in the 2000B SBR09 on the 837P.	Patient’s insurance card

The Medicare patient is the first source of health insurance eligibility information. When scheduling a medical appointment for a Medicare patient, remind them to bring all their health insurance cards showing coverage. This will help you decide who to bill for services, get the correct spelling of the patient’s first and last name, and get their Medicare number as shown on the Medicare health insurance card.

Loop 2010BA NM109 / Item 1a

Table 21: Loop 2010BA NM109 / Item 1a Fields
Insured’s ID Number	Source
Enter the patient’s MBI number whether Medicare is the primary or secondary payer. Other fields show the MAC the order of insurance payment.	Patient’s insurance card

Enter the number exactly as it appears on the patient’s insurance card.

Loop 2300 REF / Item 23

Complete when 1 of the conditions on the following slide applies.

Table 22: Loop 2300 REF / Item 23 Fields
Prior Authorization Number	Source
Item 23 varies depending on the health care professional or supplier submitting the claim. Use item 23d to report the prior authorization number, referral number, mammography pre-certification number, or Clinical Laboratory Improvement Amendments (CLIA) number, as assigned by the payer for the current service. Item 23 can contain only 1 condition. Report any other conditions on a separate CMS-1500 claim form. For the 837P, use the appropriate 2300 REF based on the value you’re reporting.	Health care professional or supplier’s records

More on Loop 2300 / Item 23

Enter the Quality Improvement Organization (QIO) prior authorization number for those procedures requiring QIO prior approval (2300 REF Prior Authorization).

If using an investigational device in an FDA-approved clinical trial:

Enter the Investigational Device Exemption (IDE) number
Place the Post Market Approval number here when applicable (2300 REF Investigational Device Exemption Number)

For physicians performing care plan oversight services:

Enter the NPI of the HHA when you bill CPT code G0181 (HH) (2300 REF Care Plan Oversight)
Enter the NPI of the hospice when you bill CPT code G0182 (Hospice) (2300 REF Care Plan Oversight)

Enter the 10-digit Clinical Laboratory Improvement Act (CLIA) certification number when billing for laboratory services that require it (2300 REF CLIA Number).

For ambulance claims, enter the ZIP Code of the loaded ambulance trip’s point-of-pickup (2310E or 2420G Ambulance Pick-up Location).