Critical Details on a CMS-1500 Box 1a 10-digit Medicaid Recipient Number Box 2 Member's Name (Last, First, Middle) Box 3 Member's Birth Date (MMDDYY) Box 4 Insured's Name (Last, First, Middle) Box 5 Member's Address Box 6 Member's Relationship to Insured (Self) Critical Claim Elements (continued)
{}