Print Insurance NOTES field in

Box 10D of HCFA 1500

j:\csr\cyber\chapter3\insnotes_box10d.htm

 

For certain DME suppliers, they are required to print a Vendor ID in box 10D of HCFA 1500 form.  This vendor ID is assigned by certain insurance companies.

 

We will handle this in the Insurance File,  1 insurance at a time.

 

Field #9, Column 6: Answer Y. 

Field #14: Notes:   Enter your Vendor ID here.  This will print in box 10D

SCRINS       I N S U R A N C E    C O M P A N I E S          A/C/END:CHANGE

 1. Ins. # : 15                        8. Attn.    : Claims Dept

 2. Name   : METROPOLITAN LIFE   \     9. Form Type: 8   N   N   N   N   Y_

 3. Address: 1234 MAIN ST.            10. Assigned : Y   11. Select Charge: 0

             LINE 2                   12. Provider Id(S) : 5

 4. City,St: LOS ANGELES, CA          13. Procedure Code Type: 1 Alternate: 2

 5. Zipcode: 90111 - 1234             14. Notes: no contract  15. Active:N

 6. Phone     : (619)256-4566         16. Bundle  Code: PPO   PPO'S

 7. Fax Phone : (619)256-1234         17. Contracted: N    18.Memo: Y

************ ADDITIONAL BILLING INFORMATION ******************************

21. Insurance Type           : N    0

22. Supplemental/Medigap(Y/N): Y   27. Medicare OCNA Key  : TEST321 22xx

23. E-Bill  Claim Type : I         28. DMERC Insurance Co : 20

24. Payor ID           : PAyid-122 29. Bill Pat After Ins Pays : Y

25. Days Past Due      : 0

26. Authorization Req'd: Y    3

 

Enter 'Y' to print this Insurance's NOTES field #14 in box 10D  of the HCFA 1500 form                                             

 

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                 Change Which # (0 For None, -1 To Abort): 9