HCFA Form, Effective January 6, 2014

 

Effective version 14.04.15

In regard to the new HCFA 1500 (02-12) Form, as of this update:

 

• When a patient (or insured) does not have a middle name, Intellect removes the comma after the first name.

• When there is no insured’s name in Box 9, ", ," has been removed.

 


 

Effective version 14.03.20
This update includes a change affecting the HCFA, BOX 9A for claims for Medi-Medi insurance patients. When the patient has MediCal as the secondary, Intellect will now pull the subscriber ID from the secondary MediCal insurance.

 


 

Effective Version 14.02.04
Prime Clinical Systems has made the necessary requirements for the new HCFA 1500 Form (02/12), scheduled for mandate on 4/1/2014.

For your office to implement the new HCFA 1500 Form (02/12):

1. Intellect must be on version 13.12.12 or greater.

2. If your office has the HCFA 1500 forms set up as an Automated Task, you must contact our PCS Support Team at (support@primeclinical.com, or by phone at 626-449-1705, to make the necessary changes to the Tasks for the new form.

    a. In the Subject Line of the email:  New HCFA Task Changes
    b. In the Body of the email: Client Id, Contact person and direct phone number.

3. If your office uses the Red and White HCFA Form, you may purchase them from Prime Clinical Systems. For more information on purchasing the New HCFA Form, please email support@primeclinical.com.

    a. In the Subject Line of the email: Order New HCFA
    b. In the Body of the email:  Client Id, contact name and direct phone number.

NOTE:  Before doing this, please be sure to test the NEW FORM by updating the Utility/Insurance/Form = NEW HCFA (For the Black and white form), NEW HCFA RED (for the Red and white form.

 


 

Efective Version 13.10.29

A new Health Insurance Claim Form (HCFA) has been released, which goes into effect January 6, 2014. Some of the changes to be aware of include:

 

 

 

 

 

Also please note the following for individual boxes on the form:

 

Box 11 Insured’s Policy Group or FECA Number:

 

 

Y4 Property Casualty Claim Number

 

Enter the qualifier to the left of the vertical dotted line.

Enter the identifier number to the right of the vertical dotted line. For example:

 

    

 

Box 14 Date of Current Illness, Injury, or Pregnancy (LMP)

 

 

Box 15 Other Date

 

 

454 Initial Treatment

304 Latest Visit or Consultation

453 Acute Manifestation of a Chronic Condition

439 Accident

455 Last X-ray

471 Prescription

090 Report Start

091 Report End

444 First Visit or Consultation

 

Box 17 Name of Referring Provider or Other Source

Before the vertical dotted line, enter the applicable qualifier to identify which provider is being reported:

 

DN Referring Provider

DK Ordering Provider

DQ Supervising Provider

 

Effective version 14.07.01, see additional information for Box 17.

 

Box 21 Diagnosis or Nature of Illness or Injury

Between the vertical dotted lines, enter the applicable ICD indicator to identify which version of ICD codes is being reported:

 

9 ICD-9-CM

0 ICD-10-CM

 

Relate lines A - L to the lines of service in 24E by the letter of the line.