The CMS 1500 imports information entered into OfficeMate.  You can edit some information directly on the CMS 1500 form, but most information must be edited in OfficeMate as described below.

Note:  OfficeMate automatically populates the appropriate form fields based on the type of insurance.  For example, if the patient is insured by Medicare, OfficeMate completes only the fields required by Medicare.

For a visual representation of of how the CMS 1500 form is populated in OfficeMate, go to http://www.officemate.net/pdfs/cms1500_Form.pdf.

CMS Box	OfficeMate field/window
Box 1	Setup > Insurance Setup > Insurance Carrier tab > Claim Form tab > Box 1 Insurance Type drop-down menu
Box 1A	Patient Center window > Demographics button > Insurance tab > Detail button > Insured ID (Box 1a) text box
Box 2	Patient Center window > Demographics button > Last Name (Box 2) and First Name (Box 2) text boxes
Box 3	Patient Center window > Demographics button > Sex radio button and Date of Birth text box
Box 4	Patient Center window > Demographics button > Insurance tab > Detail button > Insured Party Last Name and First Name text boxes (if Other or Guarantor is selected as the insured party) Medicare: Blank if the Insured Party and Patient are the same. Other Insurances: “SAME” if the Insured Party and Patient are the same.
Box 5	Patient Center window > Demographics button > Address (Box 5), City (Box 5), State/ZIP (Box 5), and Home Ph # (Box 5) text boxes
Box 6	Patient Center window > Demographics button > Insurance tab > Detail button > Relationship to Insured (Box 6) drop-down menu
Box 7	Patient Center window > Demographics button > Insurance tab > Detail button > Insured Party Address, City, State, ZIP, and Home Ph text boxes (if Other or Guarantor is selected as the insured party) Medicare: Blank if the Insured Party and Patient are the same. Other Insurances: “SAME” if the Insured Party and Patient are the same.
Box 8	Patient Center window > Demographics button > Marital Status (Box 8) and Emp. Status (Box 8) drop-down menus
Box 9–9D	Setup > Insurance Setup > Insurance Carrier tab > Claim Form tab > select Yes from the 9d Populate with Secondary Ins radio buttons
Box 10	Defaults to No. Edit directly on the CMS 1500 form.
Box 11	Patient Center window > Demographics button > Insurance tab > Detail button > Policy Group (Box 11a) text box
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
Box 17A	Setup > Resource Setup > Referring Dr tab > Qualifier (Box 17a) and Other (Box 17a) text boxes
Box 17B	Setup > Resource Setup > Referring Dr tab > NPI Number (Box 17b) text box
Box 18	Edit directly on the CMS 1500 form.
Box 19	Fee Slip window > Line Add'l Data button > Note Reference drop-down menu and Item Narrative text box.
Box 20	Edit directly on the CMS 1500 form.
Box 21	Diagnosis code in the ICD-9 field on the Fee Slip window
Box 22	Edit directly on the CMS 1500 form.
Box 23	Patient Center window > Demographics button > Insurance tab > Detail button > Eligibility tab > Authorization ID text box
	CMS 1500 form boxes 24A–24J are divided horizontally to accommodate the submission of both the NPI number and another/proprietary identifier during the NPI transition and to accommodate the submission of supplemental information to support the billed service. The top area of the six service lines is shaded and is the location for reporting supplemental information; it is not intended to allow for the billing of 12 lines of service.
Box 24A	Fee Slip window > Date Or, Fee Slip window > Line Add'l Data button > Service Date text boxes
Box 24B	All Medicare jurisdiction type claims must have box 24b on the CMS 1500 populate with 12. In order to populate box 24b with 12 at the proper time, the place of service is determined in the following order: a.       Patient level place of service (if entered in the insurance information in the Patient Demographic window) b.       Insurance plan level place of service (if entered in the Plan tab of the Insurance Setup window) -              If 12 is entered, CMS 1500 boxes 32, 32a, and 32b are blank -              If 11 is entered, no changes are made to boxes 32, 32a, or 32b c.       Product level place of service (if entered in the Products & Services window)
Box 24C	Products & Services window > Product tab > EMG text box
Box 24D	Fee Slip window > CPT field Or, Fee Slip window > Line Add'l Data button > Modifier(s) list box The CPT fields for services are extracted from the modifiers recorded on the Products & Services window:  Products & Services window > Products Tab > First Modifier and Second Modifier drop-down menus
Box 24E	Fee Slip window > ICD-9 drop-down menus
Box 24F	Setup > Insurance Setup > Plan tab > Claim Form tab > Box 24f Price Changes drop-down menu Displays fee slip fee, product cost, product fee, or third party reimbursement charges based on your selection from the Box 24f Price Charges drop-down menu. If you converted from OfficeMate Enterprise 1.x or OfficeMate 8.x or below to 9.x, the default amount displayed is the product fee; if your products and services do not have fees assigned to them, then $0.00 appears in box 24F on the CMS 1500 form.
Box 24G	Fee Slip window > Qty text fields If you are required to report NDC units, click on the arrow on the right side of box 24J and type the appropriate qualifier in the Box 24 Supplemental Information text box (F2=International Unit; ML= Milliliter; GR=Gram; UN=Unit).
Box 24H	Products & Services window > Product tab > EPDST text box If there is a requirement for you to report a reason code for EPDST, click on the arrow on the right side of box 24J and select the appropriate reason code from the EPSDT Codes drop-down menu (AV=Available; S2=Under Treatment; ST=New Service Requested; NU=Not Used; Y=Yes; N=No).
Box 24I	Setup > Insurance Setup > Insurance Carrier tab > Claim Form tab > Box 1 Insurance Type drop-down menu, if the type is different than what is already recorded in box 33B. Based on your selection from the Type drop-down menu, the following qualifiers will be populated in the shaded section of the box: Blue Cross–1A, Blue Shield–1B, Medicare–1C, Medicaid–1D, Champus–1H, Commercial–G2, Other–1G. If required or needed, enter or modify information in box 24I by clicking on the arrow on the right side of box 24J and selecting a qualifier from the drop-down menu.
Box 24J	Setup > Resource Setup > Provider tab > NPI Number (Box 24j) text box The provider’s NPI number appears in the unshaded section of the box only if it is different than the NPI number recorded in box 33A. To record supplemental information, you must click on the arrow on the right side of box 24 on the CMS 1500. Type supplemental information in the Box 24 Supplemental Information text box if you are required to report information not already recorded. Follow payer instructions for using qualifiers; when reporting a service that does not have a qualifier, type two blank spaces before typing the information. Do not enter a space between the qualifier and the number/code/information. Do not enter hyphens or spaces within the number/code. To record more than one supplemental item, type the first item, three blank spaces, and then the next item. If required or needed, enter or modify information in the shaded portion of box 24J by typing the rendering provider ID in the Box 24J Rendering Provider ID text box. Any supplemental information that you record is populated in the shaded sections of boxes 24A–24G.
Box 25	Setup > Insurance Setup > Insurance Carrier tab > Claim Form tab > Box 25 Tax ID drop-down menu To maintain tax IDs: Setup > Resource Setup > Provider tab > SSN Number (Box 25) and EIN Number (Box 25) text boxes
Box 26	Patient Center > Patient ID field
Box 27	Setup > Insurance Setup > Insurance Carrier tab > Claim Form tab > Box 27 Accept Assignment radio button
Box 28	Fee Slip window > Total Charges field
Box 29	Setup > Insurance Setup > Insurance Carrier tab > Claim Form tab > Box 29 Indicate Patient Payment on Claim and Box 29 Populate Patient's & Primary Insurance Payment radio buttons
Box 30	Fee Slip window > Total Charges field
Box 31	Setup > Resource Setup > Provider tab > Professional Sig Box 31 text box And Setup > Insurance Setup > Plan tab > Box 31 Source drop-down menu
Box 32–32B	Setup > Insurance Setup > Insurance Carrier tab > Claim Form tab > Box 32 Print Address radio button Or, Patient Center window > Demographics button > Insurance tab > Detail button > Add'l Claim Information tab > CMS Box 32 text boxs and drop-down menus To maintain location information: Setup > Location Maintenance > Select button > Qualifier (32b) drop-down menu and the Facility ID (32b) text box.
Box 33	Setup > Insurance Setup > Plan tab > Claim Form tab > Box 33 Print Home Office Address radio button > Box 33 Billing Entity drop-down menu To maintain billing provider information: Setup > Resource Setup > Provider tab > Last Name (Box 33), First Name (Box 33), Middle Name (Box 33), and Phone # (Box 33) text boxes and the Business (Box 33) drop-down menu To maintain location information: Setup > Location Maintenance > Select button > Billing Name (33) and NPI Num (33a) text boxes. If the insurance type is not Blue Cross (1A), Blue Shield (1B), Medicare (1C), Medicaid (1D), Champus (1H), or Commercial (G2), Box 33B is populated with the UPIN #: Setup > Resource Setup > Provider tab > UPIN # text box.