- The 8-Digit number Clinical Trial number should be placed in the value amount of value code D4 on the Paper Claim UB-40 (Form Locators 39-41) or in Loop 2300.
- Paper Form CMS-1500: Preceded by CT and placed in Field 19.
- Electronic: Entered without the CT prefix in Loop 2300 REF02 (REF04 = P4).
- This is driven by the Case on the Encounter.
- Select NCT as the Case Type to add the Qualifier P4.
- Add the Clinical Trial number as the Authorization Number on the Case.
Add the Case Type (NCT)
- On the Add/Modify Case Screen, select Manage in the Type dropdown.
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- In the Lookup Items popup, select Add.
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- Enter NCT in the Code field.
- Select Save [F2].
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- In the Type dropdown, select NCT.
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After the Case Type has been selected, complete the Case as normal.
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