CMS-1500 Claim Form: Detailed Guide to Boxes 31, 32 & 33 (Provider Signature, Facility & Billing Info)

Understanding the intricacies of the CMS-1500 claim form is crucial for accurate medical billing and avoiding claim denials. Boxes 31, 32, and 33 are particularly vital, covering the provider’s signature, service facility location, and billing provider information respectively. This detailed guide will walk you through the requirements for each box, clarify common questions, and help you master these critical sections to ensure timely reimbursement.

Understanding CMS 1500 Box 31: Signature of Physician or Supplier

Box 31 on the CMS-1500 form requires the signature of the physician or supplier, certifying the accuracy and completeness of the claim. This signature is a legal attestation that the services were rendered as described and are medically necessary.

Who Should Sign Box 31 on CMS-1500?

The individual legally authorized to sign the claim depends on the provider type and service. Generally, this is the rendering provider. However, various provider types are permitted to sign:

• Physicians: The treating physician or supervising physician.
• Physician Assistants (PAs) & Nurse Practitioners (NPs): PAs and NPs can sign if permitted by state law and payer regulations, and if they are the rendering provider. Yes, a PA can be in Box 31 on a 1500 if they were the rendering provider.
• Ambulance Services: For ambulance services, it is generally appropriate for an authorized representative of the ambulance service (e.g., a manager or designated billing person) to sign Box 31, provided they have the authority to certify the claim on behalf of the organization. It is typically not appropriate for a general biller without specific authorization to sign unless they are an authorized agent acting on behalf of the provider/supplier.
• Group Agencies: If the individual provider is part of a group, an authorized representative of the group may sign, especially for services rendered under the group’s NPI.

By signing the provider enrollment agreement, providers certify that all information listed on a claim for reimbursement is true, accurate, and complete. Therefore, claims may be endorsed with a computer-generated, manual, or stamped signature.

CMS 1500 Box 31 Requirements

When completing Box 31, ensure the following:

• Rendering Provider’s Name: Enter the name of the rendering provider exactly as it is registered with the payer (e.g., AHCCCS). This name should match the NPI submitted in Box 24J.
• Date: Enter the claim submission date next to the signature.
• Credentials: Include the provider’s degrees or credentials (e.g., MD, DO, PA-C, NP).

Decoding CMS 1500 Box 32: Service Facility Location Information

Box 32 is used to report the name and address of the location where the services were rendered if it is different from the billing provider’s primary office. This box is crucial for institutional settings.

When to Complete Box 32

Complete Box 32 when services are provided in an institutional setting or a location other than the billing provider’s primary office. Examples include:

• Hospitals (inpatient or outpatient)
• Skilled Nursing Facilities (SNFs)
• Nursing Homes
• Independent Diagnostic Testing Facilities (IDTFs)
• Ambulatory Surgical Centers (ASCs)
• Satellite Clinics
• Outpatient departments of hospitals
• Urgent care centers

If services are rendered at the billing provider’s primary office and the address is identical to the billing provider’s address in Box 33, Box 32 should be left blank.

Box 32A and 32B Requirements

• Box 32A (NPI of Service Facility): Enter the National Provider Identifier (NPI) of the service facility where the services were rendered. This NPI identifies the specific location.
• Box 32B (Other ID): This box is generally left blank or marked as ‘Not Applicable’ unless a specific identifier is required by the payer or in specific state-specific scenarios. Refer to individual payer guidelines for any unique requirements for Box 32B.

Mastering CMS 1500 Box 33: Billing Provider Info & Phone Number

What Does Box 33 Represent on CMS-1500?

Box 33 identifies the billing provider – the individual or organization submitting the claim and receiving payment. It is distinct from the ‘Rendering Provider’ (identified in Box 24J and often implied by the signature in Box 31) and the ‘Service Facility’ (identified in Box 32).

The billing provider can be a solo practitioner, a group practice, or an institutional provider. This box represents who the payment should be directed to.

Box 33 Information Required

Ensure the following complete and accurate information is entered:

• Billing Provider Name: The legal name of the individual or group billing for the services.
• Address: The complete street address, city, state, and 9-digit ZIP code of the billing provider’s primary office.
• Phone Number: The billing provider’s contact phone number.

Box 33A NPI of Physician or Supplier

Enter the NPI of the billing provider:

• If a group is billing, enter the Group NPI.
• If an individual practitioner is billing independently (not through a group), enter their Individual NPI.
• This NPI is crucial as it links the services rendered to the entity responsible for billing.

Box 33B Taxonomy Code of Physician or Supplier

The Taxonomy Code describes the provider’s specialty or classification. For Box 33B, it’s typically used to identify the billing provider’s specific area of practice.

• Qualifier ‘ZZ’: Enter ‘ZZ’ as the qualifier, immediately followed by the Taxonomy Code without any spaces. The ‘ZZ’ qualifier indicates that the subsequent code is a provider taxonomy code.
• Purpose of Taxonomy Code: Taxonomy codes are administrative codes developed by the National Uniform Claim Committee (NUCC) that classify the type, discipline, and/or specialty of health care providers. They help payers process claims accurately by identifying the specific nature of the billing entity’s services. You can find comprehensive information on these codes at the National Uniform Claim Committee (NUCC) website.

Difference Between Box 31 and Box 33 on CMS-1500

While both boxes are about providers, they serve distinct purposes:

• Box 31 (Signature): Identifies the individual (rendering provider or authorized agent) who personally certifies the services provided. This is about the clinical responsibility and attestation.
• Box 33 (Billing Provider): Identifies the entity (individual or group) that is submitting the claim and expects to receive payment. This is about financial responsibility and payment routing.

Common Scenarios and Troubleshooting

Navigating the nuances of Boxes 31, 32, and 33 can sometimes lead to claim denials. Here are common issues and troubleshooting tips:

• Provider Box 31 Does Not Match Location on Box 32 CMS Form (Remit Code): This is a frequent denial reason. It typically occurs when the rendering provider’s information in Box 31 (or implied by 24J) doesn’t align with the type of service facility listed in Box 32. For example, a claim for an inpatient hospital stay should have a Box 32 entry, and the rendering provider’s specialty should be consistent with services provided in that setting. Ensure the NPIs and addresses in Boxes 32 and 33 (if different) accurately reflect where the service took place and who is billing for it.
• Missing or Illegible Signature in Box 31: A claim without a valid signature in Box 31 will be denied. Ensure the signature is clear and from an authorized individual.
• Incorrect NPI or Address: Any discrepancy in the NPIs (Boxes 32A, 33A) or addresses (Boxes 32, 33) can cause denials. Double-check all numbers and addresses against your provider’s enrollment records.
• Missing Taxonomy Code: Some payers require the taxonomy code in Box 33B for proper routing and processing. Ensure it’s included with the ‘ZZ’ qualifier where necessary.
• Confusion Between Rendering, Service, and Billing Providers: Clearly understand these roles. The rendering provider delivers the service, the service facility is where it occurred, and the billing provider is the entity asking for payment. Inconsistent information across these boxes often leads to denials.

Always refer to the specific payer’s manual or guidelines for their exact requirements, as these can vary.

Frequently Asked Questions (FAQ) about CMS-1500 Boxes 31, 32 & 33