What information is included in Block 22 of the CMS-1500 form?

• A. Resubmission code and/or original reference number.
• B. The patient's date of birth.
• C. The insurance eligibility status.
• D. The facility's name.

Answer: (A)

Block 22 is where you record information about resubmitting a claim and link it to the original submission. Specifically, this field contains the Resubmission Code, which tells the payer what kind of resubmission is being submitted (for example, a replacement or a void), and the Original Reference Number, which is the identifier of the original claim being referenced. This allows the payer to track changes and tie the new submission back to the prior one. If the claim isn’t being resubmitted, this field is typically left blank.

The patient’s date of birth, insurance eligibility status, and the facility’s name are recorded in other areas of the form, not in Block 22.