CMS 1500 – type de document

Vue d'ensemble (Overview)

Le CMS-1500 est un formulaire standard pour les demandes de remboursement des frais médicaux utilisé par les prestataires et fournisseurs non-institutionnels pour facturer les transporteurs Medicare et les transporteurs régionaux d'équipements médicaux durables (DMERC). Il est également utilisé pour la facturation de certaines agences nationales Medicaid.

Ce paquet ML est entraîné pour détecter automatiquement les informations clés et extraire des données pertinentes de ce type de formulaire. Il contient plus de 80 champs couvrant tous les types d'informations que le formulaire peut contenir.

Particularités

Le modèle détecte automatiquement des données telles que :

• Nom et adresse du payeur.
• Adresse, téléphone, date de naissance du patient.
• Nom et adresse de l'assureur.
• Date de la maladie, informations sur la demande de remboursement, date d'hospitalisation.
• Nature de la maladie, nature du diagnostic, date du service, lieu du service.

Extracted fields

Remarque : si vous utilisez des points de terminaison publics, tels que https://du.uipath.com/ie/invoices, tous les champs sont disponibles. Toutefois, si vous utilisez des extracteurs formés sur mesure, la disponibilité des champs extraits dépend de la version que vous utilisez actuellement.

Vous pouvez également vérifier la liste des champs et des types surtout point de terminaison au sein de l’objet ./info/model Pour y accéder, ajoutez simplement /info/model à n’importe quel point de terminaison, comme suit : https://du.uipath.com/ie/invoices/info/model. Pour optimiser la lecture de la liste des champs, il est conseillé d’installer une extension de visionneuse JSON dans votre navigateur.

Tableau 1. Liste des champs extraits de CMS 1500

Display Name	Nom du champ	Type de champ	Type de contenu
Payment Name	payment-name	regular	string
Payment Address	payment-address	regular	string
Health Insurance Coverage Type	health-insurance-coverage-type	regular	string
Insured's I.D Number	insured-s-i-d-number	regular	string
Patient's Name	patient-name	regular	string
Patient's Address	patient-address	regular	string
Patient's Birthdate	patient-birthdate	regular	Date
Patient Relationship To Insured	patient-relationship-to-insured	regular	string
Insured's Name	insured-name	regular	string
Insured Address	insured-address	regular	string
Other Insured's Name	other-insured-name	regular	string
Other Insured's I.D.	other-insured-id	regular	string
Patient's Condition Related To Employment	condition-employment	regular	string
Patient's Condition Related To Auto Accident	condition-auto-accident	regular	string
Auto Accident State	auto-accident-state	regular	string
Insured Policy Group Or Feca Number	insured-policy-feca-id	regular	string
Insured's Birth Date	insured-birth-date	regular	Date
Insured's Gender	insured-sex	regular	string
Other Claim ID	other-claim-id	regular	string
Insurance Plan Name	insurance-plan-name	regular	string
Another Health Benefit Plan	another-health-plan	regular	string
Claim Codes	claim-codes	regular	string
Other Insurance Plan Name	other-insurance-plan	regular	string
Patient's Signature	patient-signature	regular	string
Patient's Signature Date	patient-signature-date	regular	Date
Insured's Signature	insured-signature	regular	string
Current Health Condition Date	health-condition-date	regular	Date
Current Health Qualifier	current-health-qualifier	regular	string
Other Health Condition Date	other-health-condition-date	regular	Date
Other Health Condition Qualifier	other-health-condition-qualifier	regular	string
Patient Unable To Work Date From	unable-to-work-date-from	regular	Date
Unable To Work To	unable-to-work-to	regular	Date
Name Of Referring Provider	name-of-referring-provider	regular	string
Referring Provider ID	referring-provider-id	regular	string
Referring Provider NPI	referring-provider-npi	regular	string
Hospitalization Dates From	hospitalization-dates-from	regular	Date
Hospitalization Dates To	hospitalization-dates-to	regular	Date
Additional Claim Information	additional-claim-information	regular	string
Services Outside Lab	services-outside-lab	regular	string
Charges	outside-lab-charges	regular	string
Diagnosis Codes	diagnosis-codes	regular	string
ICD Indicator	icd-indicator	regular	string
Resubmission Code	resubmission-code	regular	string
Original Reference Code	original-reference-code	regular	string
Prior Authorization Number	prior-authorization-number	regular	string
Patient's Account Number	patient-account-number	regular	string
Total Charge	total-charge	regular	string
Amount Paid	amount-paid	regular	string
Signature Of Physician Or Supplier	signature-of-physician-or-supplier	regular	string
Physician Or Supplier Signature Date	physician-supplier-signature-date	regular	Date
Service Facility Location NPI	service-location-npi	regular	string
Service Facility Location ID Number	service-location-id	regular	string
Billing Name	billing-name	regular	string
Billing Address	billing-address	regular	string
Billing Phone Number	billing-phone-number	regular	string
Billing NPI	billing-npi	regular	string
Billing ID	billing-id	regular	string
Patient's Phone Number	patient-phone-number	regular	string
Insured Phone Number	insured-phone-number	regular	string
Patient's Condition Related To Other Accident	condition-other-accident	regular	string
Reported ID Number	reported-id-number	regular	string
Assignment Acceptance	assignment-acceptance	regular	string
Patient Gender	patient-gender	regular	string
Federal Tax ID Number	federal-tax-id-number	regular	string
Service Facility Name	service-facility-name	regular	string
Service Facility Address	service-facility-address	regular	string
Medical Service Details - Date Of Service From	date-of-service-from	Eléments	Date
Medical Service Details - Date Of Service To	date-of-service-to	Eléments	Date
Medical Service Details - Place Of Service	place-of-service	Eléments	string
Medical Service Details - CPT/HCPCS	cpt-hcpcs-number	Eléments	string
Medical Service Details - Modifier	modifier	Eléments	string
Medical Service Details - Diagnosis Pointer	diagnosis-pointer	Eléments	string
Medical Service Details - Charges Amount	charges	Eléments	string
Medical Service Details - Days Or Units	days-or-units	Eléments	string
Medical Service Details - EPSDT Codes	epsdt-codes	Eléments	string
Medical Service Details - EPSDT Family Planning	epsdt-family-planning	Eléments	string
Medical Service Details - ID Qualifier	id-qualifier	Eléments	string
Medical Service Details - Rendering Provider NPI	rendering-provider-npi	Eléments	string
Medical Service Details - Rendering Provider Other ID	rendering-provider-other-id	Eléments	string
Medical Service Details - Supplemental Information	supplemental-information	Eléments	string
Medical Service Details - Emergency Indicator	emergency-indicator	Eléments	string

Échantillon

Voici quelques exemples de formulaires remplis :