| 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 |