HCFA

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The Plan Maintenance - HCFA tab maintains claims printing information about a plan.

 

Box 1

 

HCFA Box 1

Indicates if which claim type will be selected on Box 1 of the HCFA-1500 form.  Values are:

•Medicare
•Medicare
•CHAMPUS
•CHAMP/VA
•Group Health Plan
•FECA Black Lung
•Other

This is a required field.

 

 

Box 4

 

Blank on Level 1

Indicates if Box4 should be blank on the primary claim when this plan is primary.

 

Special Msg When Patient is the Subscriber

Indicates if a special message is to be used in Box 4 when this plan is primary on the primary claim and the patient is the subscriber.

 

Special Box 4 Msg

The special message to appear in Box 4 when the this plan is primary on the primary claim.  Allowable values are:

•SAME

 

 

 

Box 7

 

Blank on Level 1

Indicates if Box7 should be blank on the primary claim when this plan is primary.

 

Special Msg When Patient is the Subscriber

Indicates if a special message is to be used in Box 7 when this plan is primary on the primary claim and the patient is the subscriber.

 

Special Box 7 Msg

The special message to appear in Box 7 when the this plan is primary on the primary claim.  Allowable values are:

•SAME

 

 

 

Box 9

 

Special Msg When Patient is the Subscriber

Indicates if a special message is to be used in Box 9 when this plan is primary on the primary claim and the patient is the subscriber.

 

Special Box 9 Msg

The special message to appear in Box 9 when the this plan is primary on the primary claim.  Allowable values are:

•SAME
•SELF

 

Level 1

Indicates which insurance information will appear in Box 9 on claims for this plan when this plan is primary.  Allowable values are:

•Blank
•Previous Level of Insurance
•Current Level of Insurance
•Next Level of Insurance

 

Level 2

Indicates which insurance information will appear in Box 9 on claims for this plan when this plan is secondary.  Allowable values are:

•Blank
•Previous Level of Insurance
•Current Level of Insurance
•Next Level of Insurance

 

Level 3

Indicates which insurance information will appear in Box 9 on claims for this plan when this plan is tertiary.  Allowable values are:

•Blank
•Previous Level of Insurance
•Current Level of Insurance
•Next Level of Insurance

 

 

 

Box 10 (Condition Related To)

 

Not Applicable

Indicates if, for this plan, the software should default the "Condition Related To" to "Not Applicable".

 

Related to Employment

Indicates if, for this plan, the software should default the "Condition Related To" to "Related to Employment".

 

Related to Auto Accident

Indicates if, for this plan, the software should default the "Condition Related To" to "Related to Auto Accident".

 

 

Box 11

 

Print

Indicates what should print in Box 11 on the HCFA-1500 form.  Allowable values are:

•Policy Number
•Group Number

 

Level 1

Indicates which insurance information will appear in Box 11 on claims for this plan when this plan is primary.  Allowable values are:

•Blank
•Previous Level of Insurance
•Current Level of Insurance
•Next Level of Insurance

 

Level 2

Indicates which insurance information will appear in Box 11 on claims for this plan when this plan is secondary.  Allowable values are:

•Blank
•Previous Level of Insurance
•Current Level of Insurance
•Next Level of Insurance

 

Level 3

Indicates which insurance information will appear in Box 11 on claims for this plan when this plan is tertiary.  Allowable values are:

•Blank
•Previous Level of Insurance
•Current Level of Insurance
•Next Level of Insurance

 

 

 

Box 17

 

Source

Indicates what should print in Box 17 on the HCFA-1500 form.  Allowable values are:

•Referring
•PCP

 

17A

Indicates what should print in Box 17a on the HCFA-1500 form.  Leaving this field EMPTY will default the UPIN # into Box 17a on the claim form.

Other allowable values are:

•Blank - Will leave Box 17a on the HCFA form BLANK
•UPIN - Print the Referring or PCP UPIN
•UDF1 - Print the Referring or PCP User-Defined Field 1
•UDF2 - Print the Referring or PCP User-Defined Field 2
•UDF3 - Print the Referring or PCP User-Defined Field 3
•UDF4 - Print the Referring or PCP User-Defined Field 4

.

 

 

 

Detail Items

 

HCFA Box 24d

Indicates what coding system should be printed in Box 24D.

•CPT
•ASA
•HCPCS
•OTHER

This is a required field.

HCFA Box 24g

Indicates what the default value to be used in the claim detail units should be.  This value may be overridden for a specific procedure in the Procedure Setup, or by the Fee Schedule for a specific procedure.

 

•Quantity
•Minutes
•Total Units
•Base Units
•Time Units
•All Units Except Base Units

This is a required field.

Anes Text

Indicates what procedure code value should print in the Anesthesia Text block on the HCFA-1500 form.  Allowable values are:

•CPT
•ASA
•HCPCS
•OTHER

 

 

 

Claim Totals

 

"SEE  EOB" in Boxes 28 and 30

Indicates that the literals "SEE" and "EOB" should be printed in Boxes 28 and 30 respectively on the HCFA-1500 form for secondary and tertiary insurance claims.

Claim Totals in Boxes 28 and 30

Indicates that the claim totals should be printed in Boxes 28 and 30 respectively on the HCFA-1500 form for secondary and tertiary insurance claims.

 

 

Page Totals

 

Page Totals on each Page

Indicates that a claim total for each page of the claim should be printed in the totals boxes on the claim.

CONT'D w/ Totals on last Page

Indicates that the literal "CONT'D" should be printed for each page of the claim other than the last page and the claim totals should be printed in the totals boxes on the last page of the claim.