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Eclaims | HCFA-1500 Box 23 - Prior Authorization Number
Eclaims | HCFA-1500 Box 24b - Place of Service
Eclaims | HCFA-1500 Box 26 - Patient's Account No.
Eclaims | HCFA-1500 Box 33b - Other ID
Eclaims | HCFA-1500 Box 12 - Patient's or Authorized Person's Signature
Eclaims | HCFA-1500 Box 11 - Insured's Policy Group or FECA Number
Eclaims | HCFA-1500 Box 7 - Insured's Address
Eclaims | HCFA-1500 Box 17a - Other ID
Eclaims | HCFA-1500 Box 17b - NPI
Eclaims | HCFA-1500 Box 31 - Signature of Physician or Supplier ...
Eclaims | HCFA-1500 Box 21 - Diagnosis or Nature of Illness or Injury
Eclaims | HCFA-1500 Box 1 - Insurance Type
Eclaims | HCFA-1500 Box 0 - Carrier Block
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