Insurance claims — form improvements

Patient-subscriber relationship

A relationship selector on the claim form lets you specify the relationship between the patient and the insurance subscriber. This is required for CMS 1500 Box 6. Options include:

• Self — the patient is the subscriber.
• Child — the patient is a dependent child of the subscriber.
• Other — any other relationship (e.g., spouse, domestic partner).

Select the appropriate relationship to ensure the claim form is completed correctly. When 'Self' is selected, some subscriber fields are pre-filled from the patient profile.

NPI validation

The provider NPI field includes real-time validation with clear error messages. If the NPI entered does not match the expected format or is not recognized, a specific message appears explaining the issue and how to resolve it. Common scenarios:

• Invalid format — NPI must be 10 digits.
• NPI not found in the organization's provider configuration — update the provider profile first.

Box 12 — signature indicator

The signature indicator for Box 12 (patient or authorized person signature) shows a clearer status of whether the required signature/authorization is on file, so you can tell at a glance whether this box will be satisfied before you export the claim.

CPT and HCPCS fields — searchable inputs

The CPT and HCPCS procedure code fields are searchable inputs instead of plain text fields. Start typing a code or a keyword and matching codes appear in a dropdown, which reduces typos and speeds up entry on service lines.

Diagnosis code dropdowns

Diagnosis codes (ICD-10) can be entered using a searchable dropdown. Start typing a code or keyword and the list of matching ICD-10 codes appears. The field validates in real time and flags codes that are:

• Not formatted correctly.
• Inactive or retired in the current ICD-10 code set.

You can add multiple diagnosis codes per claim. The order of codes on the form corresponds to the order on the CMS 1500 (Boxes 21A–21L).

Total charge auto-calculation

The total charge field (CMS 1500 Box 28) is calculated automatically from the sum of all service line charges. The field updates as you add, edit, or remove service lines. You no longer need to enter the total manually.

Box 33 — billing provider entity type

A radio button in Box 33 lets you specify whether the billing provider is an organization or an individual:

• Organization — billing under an organization NPI. The organization name and NPI are displayed.
• Individual — billing under an individual provider NPI. The provider name and NPI are displayed.

This toggle preserves previously saved values in dependent fields when you switch between Organization and Individual, so you don't have to re-enter data if you toggle by mistake.

Select the correct entity type to match your clearinghouse requirements. Incorrect selection may cause claim rejection.

A qualifier dropdown for Box 33 (to keep it consistent with Box 32) is still in development and is not part of this article yet — it will be added once that work ships and is confirmed.

Editing a claim after the visit has been invoiced

As of Release #41, modifiers, place of service, and diagnosis pointers on this form can be edited even after the underlying visit has been invoiced, as long as the change doesn't affect the total billed amount. See "Insurance claims — how to create, validate, and export" for details.