Prompt | Response | Req | Len |
---|---|---|---|
Location Code | Type the code you want or click the magnifying glass to search the table. This code cannot begin with a zero. | 6 | |
Location Name | Type the name of the location. | 60 | |
Printing Name | Location Name to print on HCFA's printed using HCFA WIZARD. | 27 | |
Address Line One | Type the address for this location. | 25 | |
Address Line Two | Type any additional address information for this location. | 25 | |
Zip Code | Type the zip code. | 10 | |
City | Type the city. | 20 | |
State | Type the State. | 25 | |
Country Code | Select a country from the Country list. | 2 | |
Subdivision | 2 | ||
Phone Number | Type the phone number for this location. | 20 | |
Override Ins. Billing | If you always want to file charges for this location to insurance, select this check box. | 1 | |
HCFA Place of Service Code | Type the Equivalent code you want to use on insurance claims for this insurance carrier. For more information see the Equivalent Code help section under Introduction, System Processes. | 5 | |
MEDICARE Place of Service Code | Type the Equivalent code you want to use on insurance claims for this insurance carrier. For more information see the Equivalent Code help section under Introduction, System Processes. | 5 | |
BCBS Place of Service Code | Type the Equivalent code you want to use on insurance claims for this insurance carrier. For more information see the Equivalent Code help section under Introduction, System Processes. | 5 | |
DMERC Place of Service Code | Type the Equivalent code you want to use on insurance claims for this insurance carrier. For more information see the Equivalent Code help section under Introduction, System Processes. | 5 | |
Medicaid Place of Service Code | Type the Equivalent code you want to use on insurance claims for this insurance carrier. For more information see the Equivalent Code help section under Introduction, System Processes. | 5 | |
UB Billing | Check the box if this location sends UB claims from this office | 1 | |
UB Type of Bill | Type the provider/facility number for this location, if applicable. | 3 | |
UB Location Equivalent | 3 | ||
Medicare Prov/Facility Number | Type the provider/facility number for this location, if applicable. | 15 | |
Medicaid Prov/Facility Number | Type the provider/facility number for this location, if applicable. | 15 | |
BC Prov/Facility Number | Type the provider/facility number for this location, if applicable. | 15 | |
Location NPI Number | Type the NPI number for this location, if applicable. | 10 | |
CLIA Number | Type the CLIA Number, if applicable to this location. | 30 | |
Mammography Certificate | Type the Mammography Certificate Number, if applicable to this location. | 30 | |
Fee Schedule | Select the Fee Schedule option applicable to this location. | 1 | |
Suppress Encounter | Community Health Centers only - If procedures posted for this Location code are not considered encounters, select this check box. | 1 |