! 1) HCFA Block 31 – Prints “SIGNATURE ON FILE”.
2) HCFA Block 33 – will print doctor’s pin# in 33 and 24k and group # in 33 when doctor specialty is 5, otherwise will print facility pin#.
@ HCFA Block 33 – Prints first line from Provider Master, last three lines from pers.
# UB92 Block 1 – Prints first line from Pers, last three lines from Dr Master.
$ 1) HCFA Block 24k & 33 – Prints PIN# in 24k and prints Pin # & Grp # in 33 (whether there is a Group # or not). (#4)
2) HCFA Block 23 - CLIA number won’t print on form.
% HCFA Block 25 – Prints Federal Suffix after Federal ID.
1 HCFA Block 33 – Prints Group # and Pin #.
2 HCFA Block 24k & 33 – Prints group # after Pin # in 33 and nothing in Block 24k.
3 HCFA Block 33 - Prints Doctor’s SSN after Pin #.
4 HCFA Block 24k & 33 – Prints PIN# in 24k and prints Pin # & Grp # in 33 (whether there is a Group # or not).
5 1) Will print address at top of HCFA for Medicare (#P).
2) HCFA Block 24k & 33 – Prints PIN# in 24k and prints Pin # & Grp # in 33 (#4).
6 HCFA Block 31 – will print Provider ID.
7 HCFA Block 11C – will print first 7 digits of 3rd comment line in Patient Master.
Will send same 7 digits to DA0-11.
8 HCFA Block 24H – will print “E” in 24H instead of “X”.
9 1) HCFA Block 31 – will print facility name instead of doctor name.
2) HCFA Block 33 – will print doctor’s pin# in 33 and 24k (for doctor spec 5 or 43) and group # in 33 (for doctor spec 5), otherwise will print facility pin#.
3) UB92 – prints Signature on File at bottom of form.
0 HCFA Block 9 – leaves it blank.
A HCFA Block 10D – will print Payor ID.
B ECS – Won’t send remarks.
C HCFA Block 13 – suppresses “Signature on File”.
D HCFA Block 31 - when regenerating a claim the date will print as today.
E HCFA Block 31 – will print doctor’s name in one line.
F HCFA Block 19 (right side) – prints 2 digit code from charge remark.
G HCFA Block 24k & 33 – prints doctor’s PIN in 24k and in 33 after GRP#.
H HCFA Block 1 - Wisconsin Medicaid Carrier HIRSP should print “P” in Field “Other”.
I 1) HCFA Block 24g – Prints the number of minutes when capturing claims to file.
2) HCFA Block 10D – will print Payor ID. (#A)
J HCFA Block 12 – suppresses “Signature on File”.
K HCFA Block 23 – Prints “Documentation Attached”.
L HCFA Block 31 & BA0-23 (IL) – Doctor’s State License Number.
M 1) HCFA Block 24 - Causes the short date MMDDYY to be printed instead of long date. (#S).
2) HCFA Block 24k & 33 – Prints PIN# in 24k and prints Pin # & Grp # in 33 (#4).
N HCFA Block 24g – Will print units instead of minutes on Anesthesia claims.
O HCFA Block 11c – Will print 30 characters of insurance comments instead of carrier name.
P Medicare HCFA - Causes the address to be printed on the top of the form.
UB92 Box 84 – Prints carrier name and address.
Q 1) Will print address at top of HCFA.
2) HCFA Block 23 - will not print CLIA #.
R HCFA Block 22 – When regenerating a box will appear asking for the reference number, which will print in the second part of block 22.
S HCFA Block 24 - Causes the short date MMDDYY to be printed instead of long date.
T HCFA Block 24C – won’t print TOS.
U HCFA Block 24 - Will print “SEE NEXT PAGE” on the HCFA if there are more than 6 procedure lines. (NOTE: This is against Medicare guidelines.)
V HCFA Block 24k & 33 –
If there is a Group #: Will print the Group # after “PIN#” instead of after “GRP#” and prints the Pin # in 24k.
If no Group #: Prints Pin # in 24k, leaves ID’s in Block 33 blank.
W HCFA Block 26 – Will print Patient Number without the Transaction Number.
X 1) HCFA Block 23 - CLIA number won’t print on form.
2) HCFA Block 24 - Will print “SEE NEXT PAGE” on the HCFA if there are more than 6 procedure lines. (NOTE: This is against Medicare guidelines.)
Y 1) HCFA Block 24G – will print units instead of minutes on Anesthesia claims.
2) HCFA Block 24 – will print the CPT Description on the next CPT line instead of the next CPT. This is needed for some commercial carriers.
Z V HCFA Block 24k & 33 –
If there is a Group #: Will print the Group # after “PIN#” instead of after “GRP#” and prints the Pin # in 24k.
If no Group #: Prints Pin # in 24k, leaves ID’s in Block 33 blank.
X 1) HCFA Block 23 - CLIA number won’t print on form.
2) HCFA Block 24 - Will print “SEE NEXT PAGE” on the HCFA if there are more than 6 procedure lines. (NOTE: This is against Medicare guidelines.)
Modifier 4 and California Medicaid (Medical)
Anything coded in Modifier 4 will print in Block 24H. (NOTE: does not check for valid codes.)