The first line which is line 1 and line 1a should have insurance information like Medicare Tricare if applicable to patient. Line 2, 3, and 5 should have a patients demographics such as name, age, race, gender and address, while line 4, 6, 9, 11 a, c, d should have insured patient’s insurance information like group number while line 10 should have a patient’s employment status while line 12 and 13 is a patient’s authorization which is their signature. The bottom portion of the CMS 1500 02/12 claims form is the clinical portion. Block 21 is the diagnostic codes for a patient’s condition, while Block 24 is date of services and prices for services. Block 25 is the Employer identification number (EIN) which is a federal tax ID.…