Boxes 12 and 13 on the CMS 1500 form are very important and often overlooked. When I say overlooked, I mean most don’t understand the importance of the boxes and just fill them in blindly. It is important to understand what they mean and ensure they are completed as they can seriously affect the payment of claims if not completed properly.
Box 12 is the release information box. Many think that if you don’t need to disclose any information, you can just leave it blank. Others think you just paste “signature on file” there and it’s good. Well, neither is correct. Many carriers will not release payment if this box is left blank. But just sticking “signature on file” in it is also not correct. You really need to know that the patient’s signature is on file with the provider you are billing for. The patient should have signed a release of information when they first came in. It is usually part of the first paperwork they fill out. If you are a billing service, ask your healthcare providers when you are going to do the billing, if they have these statements on file for all patients so that you can sign all claims. In any case, this is an important box that you should pay attention to.
Box 13 is the authorization to pay for medical benefits to the service provider. If this box is filled in, the patient indicates that they want all payments for the services being charged to be sent directly to the provider. This does not guarantee that the insurance company will pay the provider, but it indicates that the patient consents. For example, if the provider has no network, the insurance company can send payment directly to the patient, even if this box is filled. And if the provider is in-network, but this box is left blank, it’s possible that the payment will go to the patient. So again, if you have the patient’s authorization for payment to the provider, make sure this box is filled out.