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Guarantor/Program Billing Defaults - Electronic HCFA-1500 Section - PM

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Set the Electronic HCFA-1500 billing file default values.

  1. In the Submitter EIN# (HCFA 'AA0') field, enter the value for the submitter EIN# column of the HCFA 1500 billing file, AA0 record.
  2. In the Receiver ID# (HCFA 'AA0') field, enter the value for the receiver ID# column of the HCFA 1500 billing file, AA0 record.
  3. In the Receiver Sub ID# (HCFA 'AA0') field, enter the value for the receiver sub ID# column of the HCFA 1500 billing file, AA0 record.
  4. In the Test/Production Indicator (HCFA 'AA0') field, select the value from the list.
    Note: This value is included in the Test/Production Indicator column of the HCFA 1500 billing file, AA0 record.
  5. In the Contact Name (HCFA 'AA0') field, enter the value for the contact name column of the HCFA 1500 billing file, AA0 record.
  6. In the Version Code Over-Ride (HCFA 'AA0') field, enter the value for the version code column of the HCFA 1500 billing file, AA0 record.
  7. In the Version Code Local (HCFA 'AA0') field, enter the value for the version code local column of the HCFA 1500 billing file, AA0 record.
  8. In the Address Information To Print (HCFA 'AAO') field, select Provider Data From 'Facility Defaults' to use the information from the Facility Defaults form. Select Program Extended Dictionary to use the address information based on the program the service was posted under. The address information is filed within extended dictionaries attached to the Program data element.
  9. In the Provider Number (HCFA 'BA0') field, enter the value for the provider number column of the HCFA 1500 billing file, BA0 record.
  10. In the Filler Over-Ride (HCFA 'BA0' field 28) field, enter the value for the filler (field 28) column of the HCFA 1500 billing file, BA0 record.
  11. In the Organization Type (HCFA 'BA1') field, select the value from the list.
    Note: This value is included in the organization type column of the HCFA 1500 billing file, BA1 record.
  12. In the Provider Pay-To Address 1 Over-Ride (HCFA 'BA1' field 13) field, type the the override value for the provider pay to address 1 (field 13) column of the HCFA 1500 billing file, BA1 record.
  13. In the Provider Pay-To Address 2 Over-Ride (HCFA 'BA1' field 14) field, type the the override value for the provider pay to address 2 (field 14) column of the HCFA 1500 billing file, BA1 record.
  14. In the Provider Pay-To ZIP Over-Ride (HCFA 'BA1' field 17) field, type the override value for the provider pay to ZIP code (field 17) column of the HCFA 1500 billing file, BA1 record.
  15. In the Provider Pay-To City Over-Ride (HCFA 'BA1' field 15) field, type the override value for the provider pay to city (field 15) column of the HCFA 1500 billing file, BA1 record.
  16. In the Provider Pay-To State Over-Ride (HCFA 'BA1' field 16) field, select the state the override value for the provider pay to state (field 16) column of the HCFA 1500 billing file, BA1 record.
  17. In the Remarks Over-Ride (HCFA 'XA0' field 22) field, enter the value for the Remarks column of the HCFA 1500 billing file, XA0 record.
    Note: This column remains blank if there is no entry in this field.
  18. In the Maximum Number Of Services Within Each 'CA0 - XA0' Record Set field, type the number of services to include for each client with the electronic bill.
    Note: This is an integer-text data element.
  19. In the Include Claim Number In Patient Control Number Within 'CA0'- 'XA0' field, select Yes to include the claim number within the patient control number; select No to exclude it.
  20. In the Payor Organization Identification (HCFA 'DA0' field 7) field, enter the value for the payor organization identification (field 7) column of the HCFA 1500 billing file, DA0 record.
  21. In the Payor Claim Office Number (HCFA 'DA0' field 8) field, enter the value for the payor claim office number (field 8) column of the HCFA 1500 billing file, DA0 record.
  22. In the Exclude DA2 Record Without Corresponding 'DA1' field, select Yes to exclude the DA2 record when a DA1 record does not exist; select No to always include the DA2 record.
  23. In the Include 'EA1' Record field, select: 
    • Yes to include the EA1 record in the file.
    • No to always exclude the EA1 record.
  24. In the Transmittal Record Type field, select None to create a test file that is not for transmittal. Select $$ADD to create the actual electronic billing file.
  25. In the Identification Code field, enter the value for the Identification code. This field is active and required when $$ADD is selected in the Transmittal Record Type field.
  26. In the Batch Identification Code field, type the batch identification code value in the field.
    Note: This field is active and required when $$ADD is selected in the Transmittal Record Type field.
  27. In the Include 'AA0' and 'ZA0' Records In The Total Record Counts (HCFA 'ZA0') field, select:
    • Yes to include the AA0 and ZA0 records in the total record count
    • No to exclude them from the total.
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