Ritten automatically populates CMS-1500 fields from data in the client chart, facility configuration, payer configuration, service rules, and global variables. Use this reference to identify where each field comes from and whether it is required for clearinghouse submission.
Important: Claim data is captured at the time the claim is created. To update a specific claim and all future claims, archive the claim, update the underlying data, and recreate the claim.
Field | Data Source | Required for Submission | Notes |
Box 1 - Claim Filing Code | Payer Group Config (Claim Filing Code) | Yes | |
Box 1 - Payer ID | Payer Config (Payer ID) | Yes | |
Box 1 - Payer Name | Payer Config (Payer Name) | Yes | |
Box 1 - Payer Address - Line 1 | Payer Config (Street) | No | |
Box 1 - Payer Address - Line 2 | Not Automatically Populated | No | |
Box 1 - Payer Address - City | Payer Config (City) | No | |
Box 1 - Payer Address - State | Payer Config (State) | No | |
Box 1 - Payer Address - Zip Code | Payer Config (Postal Code) | No | |
Box 1a - Insured Member ID | Client Chart (Member ID) | Yes | |
Box 2 - Patient - First Name | Client Chart (First Name) | No | |
Box 2 - Patient - Last Name | Client Chart (Last Name) | No | |
Box 2 - Patient - Middle Name | Client Chart (Middle Name) | No | |
Box 3 - Patient - DOB | Client Chart (Date of Birth) | Yes | |
Box 3 - Patient - Sex | Client Chart (Birth Sex) | Yes | |
Box 4 - Insured's Name - First Name | Client Chart (client first name if self-insured; subscriber first name if other insured) | No | |
Box 4 - Insured's Name - Middle Name | Client Chart (client middle name if self-insured) | No | |
Box 4 - Insured's Name - Last Name | Client Chart (client last name if self-insured; subscriber last name if other insured) | No | |
Box 5 - Patient Address - Line 1 | Client Chart Primary Address (Street Address) | Yes | |
Box 5 - Patient Address - Line 2 | Client Chart Primary Address (Address Line 2) | No | |
Box 5 - Patient Address - City | Client Chart Primary Address (City) | Yes | |
Box 5 - Patient Address - State | Client Chart Primary Address (State) | Yes | |
Box 5 - Patient Address - Zip Code | Client Chart Primary Address (Postal Code) | Yes | |
Box 5 - Patient Address - Phone | Client Chart (Primary Phone Number) | No | |
Box 6 - Patient's Relationship to Insured | "Self" unless "Subscriber different than client?" is checked, in which case it uses "Relationship to Client" | Yes | |
Box 7 - Insured's Address - Line 1 | Client address if self-insured; subscriber address in Funding if other insured | Yes | |
Box 7 - Insured's Address - Line 2 | Client address if self-insured; subscriber address in Funding if other insured | No | |
Box 7 - Insured's Address - City | Client address if self-insured; subscriber address in Funding if other insured | Yes | |
Box 7 - Insured's Address - State | Client address if self-insured; subscriber address in Funding if other insured | Yes | |
Box 7 - Insured's Address - Zip Code | Client address if self-insured; subscriber address in Funding if other insured | Yes | |
Box 7 - Insured's Address - Phone | Client address if self-insured; subscriber address in Funding if other insured | No | |
Box 9 - Other Insured - First Name | Client Chart Secondary Funding | No | |
Box 9 - Other Insured - Middle Name | Client Chart Secondary Funding | No | |
Box 9 - Other Insured - Last Name | Client Chart Secondary Funding | No | |
Box 9a - Other Insured - Member ID | Client Chart Secondary Funding | No | |
Box 9 - Other Insured - Patient's Relationship to Insured | Client Chart Secondary Funding | No | |
Box 9 - Other Insured - Payer ID | Client Chart Secondary Funding | No | |
Box 9a - Other Insured - Policy Number | Client Chart Secondary Funding | No | |
Box 9d - Other Insured - Insurance Plan or Program Name | Client Chart Secondary Funding | No | |
Box 10a - Employment | Global Variables | No | |
Box 10b - Auto Accident | Global Variables | No | |
Box 10c - Other Accident | Global Variables | No | |
Box 10d - Claim Codes | Not Automatically Populated | No | |
Box 11 - Insured's Policy Number | Client Chart (Group Number) | No | |
Box 11 - Insured's Policy - DOB | Client Chart (client DOB if self-insured; subscriber DOB if other insured) | Yes | |
Box 11 - Insured's Policy - Sex | Client Chart (client birth sex if self-insured; subscriber sex if other insured) | Yes | |
Box 11 - Insured's Policy - Other Claim ID | Not Automatically Populated | No | |
Box 11 - Insured's Policy - Other Claim ID Qualifier | Not Automatically Populated | No | |
Box 11 - Insured's Policy - Plan Name | Payer Config (Payer Name) | No | Required when qualifier is present |
Box 11 - Another Health Benefit Plan | "Yes" if multiple funding sources are on the client chart; otherwise "No" | No | |
Box 12 - Patient Signature | Date the claim was created | Yes | |
Box 13 - Agree Checkbox | Checked by default | Yes | |
Box 14 - Date of Illness, Injury, or Pregnancy | Not Automatically Populated | No | Required if date of illness qualifier is present |
Box 14 - Date of Illness Qualifier | Not Automatically Populated | No | Required if date of illness is present |
Box 15 - Other Date | Not Automatically Populated | No | Required if Other Date Qualifier is present |
Box 15 - Other Date Qualifier | Not Automatically Populated | No | Required if Other Date is present |
Box 16 - Unable to Work Date - From | Not Automatically Populated | No | Required if Unable to Work To Date is present |
Box 16 - Unable to Work Date - To | Not Automatically Populated | No | Required if Unable to Work From Date is present |
Box 17 - Referring Provider - Qualifier | Not Automatically Populated | No | Required if Box 17 first, middle, or last name are present |
Box 17 - Referring Provider - First Name | Not Automatically Populated | No | |
Box 17 - Referring Provider - Middle Name | Not Automatically Populated | No | |
Box 17 - Referring Provider - Last Name | Not Automatically Populated | No | |
Box 17a - Referring Provider - Secondary ID Type | Not Automatically Populated | No | Required if secondary ID is present |
Box 17a - Referring Provider - Secondary ID | Not Automatically Populated | No | Required if secondary ID type is present |
Box 17b - Referring Provider - NPI | Not Automatically Populated | No | |
Box 18 - Hospitalization Date - From | Not Automatically Populated | No | |
Box 18 - Hospitalization Date - To | Not Automatically Populated | No | |
Box 19 - Additional Claim Information | Not Automatically Populated — enter manually on the claim if required by your payer (e.g., 42 CFR Part 2 NTE text) | No | |
Box 20 - Outside Lab - Yes/No | Global Variables | No | Required to be "Yes" when outside lab charges are greater than $0 |
Box 20 - Outside Lab - Charges | Global Variables | No | |
Box 21 - Diagnosis Code - ICD Index | Automatically populated with "0" | Yes | Must be 9 or 0 |
Box 21a - Diagnosis Code (primary) | Client Chart (Diagnosis) | Yes | |
Box 21b–l - Additional Diagnosis Codes | Client Chart (Diagnosis) | No | |
Box 22 - Resubmission Code | Automatically populated with "1" for original submissions | No | Change to "7" for corrected claims; add ICN in Original Ref No field |
Box 22 - Original Reference Number (ICN) | Not Automatically Populated | No | Max 18 characters; required for corrected claim resubmissions |
Box 23 - Prior Authorization Number | Client Chart (Authorization record). Payer and procedure code must match the claim, and the authorization must be entered before the claim is created. | No | |
Box 24a - Date From | Encounter Date | Yes | |
Box 24a - Date To | Encounter Date | Yes | |
Box 24b - Place of Service | Service Rules | Yes | |
Box 24c - EMG | Not Automatically Populated | No | |
Box 24d - Procedure Code | Service Rules | Yes | |
Box 24d - Modifiers | Service Rules | No | |
Box 24e - Diagnosis Pointer | Automatically populated with letters A through L based on the diagnoses on the client chart | Yes | Fewer than 4 characters; only letters A through L |
Box 24f - Charges | Fee Schedules (rate × units for this service line) | Yes | |
Box 24g - Units | Service Rules and Encounter Duration | Yes | Must be 1 or greater |
Box 24h - EPSDT | Not Automatically Populated | No | |
Box 24j - Rendering Provider NPI | Service Rules or Global Variables | Yes | Must be a 10-digit NPI |
Box 25 - Federal Tax ID | Federal Tax ID (EIN) of the facility configured as billing provider in Global Variables | No | |
Box 25 - Tax Number Type | Defaulted to "EIN" | No | |
Box 26 - Patient Account Number | Automatically generated — unique per claim | Yes | Exactly 20 characters |
Box 27 - Accept Assignment | Global Variables | Yes | Yes/No |
Box 28 - Total Charge | Sum of Box 24f across all service lines — not editable | Yes | Must be $0 or greater |
Box 29 - Amount Paid | Populated with "$0" | Yes | Must be 0 or greater |
Box 31 - Physician Signature | Defaults to claim creation date | No | |
Box 32 - Service Facility | Facility associated with the program the client was enrolled in at date of service. Falls back to Global Variable if no facility is set on the program. Left blank if neither is configured. | No | Applies to all Box 32 sub-fields (name, address, NPI, other ID) |
Box 33 - Billing Provider - Entity Type | Defaulted to "Organization" | Yes | Individual or Organization |
Box 33 - Billing Provider - Phone | Facility set as billing provider in Global Variables | Yes | |
Box 33 - Billing Provider - Organization Name | Facility set as billing provider in Global Variables | Conditional | Required if Entity Type is Organization |
Box 33 - Billing Provider - First Name | Not Automatically Populated | Conditional | Required if Entity Type is Individual |
Box 33 - Billing Provider - Middle Name | Not Automatically Populated | No | Required if Entity Type is Individual |
Box 33 - Billing Provider - Last Name | Not Automatically Populated | Conditional | Required if Entity Type is Individual |
Box 33 - Billing Provider - Address Line 1 | Facility set as billing provider in Global Variables | Yes | |
Box 33 - Billing Provider - Address Line 2 | Facility set as billing provider in Global Variables | No | |
Box 33 - Billing Provider - City | Facility set as billing provider in Global Variables | Yes | |
Box 33 - Billing Provider - State | Facility set as billing provider in Global Variables | Yes | |
Box 33 - Billing Provider - Zip Code | Facility set as billing provider in Global Variables | Yes | |
Box 33 - Billing Provider - NPI | Facility set as billing provider in Global Variables | Yes | |
Box 33 - Billing Provider - Taxonomy Code | Facility set as billing provider in Global Variables | No |
Updating Claim Data
If you need to correct a field on a submitted or draft claim, archive the claim, update the underlying data in the chart or configuration, and recreate the claim. Fields are not re-evaluated on existing claims after creation.