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October 19, 1999
The difference between HCFAFILE.EXE and HCFA11.EXE is that HCFAFILE.EXE will print both the policy and group numbers in Item 11, while HCFA11.EXE only prints a group number.
This document will explain where each field is pulled from within the MediSoft Patient Accounting program and the conditionals on each.
Items to Note
- The program will uppercase all letters and strip all punctuation from the form. Exceptions to the punctuation rule are lines that require a comma to separate the last name from the first name (Items 2, 4, and 31). Also excluded are the local use items (Items 10d and 19). This affects the whole line not just the individual item. In other words, for each line that requires a last, first I format, the program will not strip punctuation for anything included on that line.
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Dates include the four-digit year.
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Does not bill secondary carriers other than in MediGap situations.
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Does not print or calculate payments.
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Prints 66 lines each with a carriage return / line feed to terminate the line.
- Carriage return / linefeed characters are placed at columns 80 and 81, respectively, unless a width value is entered in the EMC Receiver Extra 1 field. Then this value is used as the width of the file. The value cannot exceed 255.
File Mapping
Each field saved to the claim file created by HCFAFILE or HCFA11 is noted below. The item number is given, followed by the line and column number location in the file. The description gives detailed information about each field.
| Item | Line/Column | Description |
| Top 1 | Line 1 col 46 | Primary Insurance Name |
| Top 2 | Line 2 col 46 | Primary Insurance Street 1 |
| Top 3 | Line 3 col 46 | Primary Insurance City (Space) State (Space) Zip |
| Item 1 | Line 7 col 2 | If primary insurance type is "Medicare" Print: "X" |
| Line 7 col 8 | If primary insurance type is "Medicaid" Print: "X" | |
| Line 7 col 16 | If primary insurance type is "Champus" Print: "X" | |
| Line 7 col 24 | If primary insurance type is "ChampVA" Print: "X" | |
| Line 7 col 32 | If primary insurance type is "Group" Print: "X" | |
| Line 7 col 40 | If primary insurance type is "FECA" Print: "X" | |
| Line 7 col 46 | Any other insurance type Print: "X" | |
| Item 1a | Line 7 col 51 | Policy Number #1 |
| Item 2 | Line 9 col 2 | Patient Last Name "," (Space) First Name (Space) Middle Initial |
| Item 3 | Line 9 col 32 | Patient’s Date of Birth |
| Line 9 col 43 | If patient’s sex is male Print: "X" | |
| Line 9 col 48 | If patient’s sex is female Print "X" | |
| Item 4 | Line 9 col 51 | If insurance type is not "Medicare" Print: Primary Insured’s Last Name "," (Space) First Name (Space) Middle Initial. Otherwise leave blank |
| Item 5 | Line 11 col 2 | Patient’s Street #1 |
| Item 6 | Line 11 col 34 | If patient’s relationship to primary insured is Self Print: "X" |
| Line 11 col 39 | If patient’s relationship to primary insured is Spouse Print: "X" | |
| Line 11 col 43 | If patient’s relationship to primary insured is Child Print: "X" | |
| Line 11 col 48 | If patient’s relationship is anything other than Self, Spouse, or Child Print: "X" | |
| Item 7 | Line 11 col 51 | If insurance type is not "Medicare" Print: Primary Insured’s Street #1. Otherwise leave blank. |
| Item 5 | Line 13 col 2 | Patient’s city |
| Line 13 col 28 | Patient’s state | |
| Item 8 | Line 13 col 36 | If the patient’s marital status is "single" Print: "X" |
| Line 13 col 42 | If the patient’s marital status is "married" Print: "X" | |
| Line 13 col 48 | If the patient’s marital status is anything else Print: "X" | |
| Item 7 | Line 13 col 51 | If the primary insurance type is not "Medicare" Print: Primary Insured’s City. Otherwise leave blank. |
| Line 13 col 76 |
If the primary insurance type is not "Medicare" Print: Primary Insured’s state. Otherwise leave blank. |
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| Item 5 | Line 15 col 2 | Patient’s zip code |
| Line 15 col 16 | Patient’s phone #1 | |
| Item 8 | Line 15 col 36 | If patient’s employment status is "Full Time" or "Part Time" Print: "X" |
| Line 15 col 42 | If patient’s student status is "Full Time" Print: "X" | |
| Line 15 col 48 | If patient’s student status is "Part Time" Print: "X" | |
| Item 7 | Line 15 col 51 | If the primary insurance type is not "Medicare" Print: Primary Insured’s Zip Code. Otherwise leave blank |
| Line 15 col 66 | If the primary insurance type is not "Medicare" Print: Primary Insured’s Phone #1. Otherwise leave blank | |
| Item 9 | Line 17 col 2 | If a secondary insurance carrier exists for this case Print: Secondary Insured’s last name "," (space) first name (space) middle initial. |
| Item 10 | Line 17 | Blank |
| Item 11 | Line 17 col 51 | If the primary insurance carrier is Medicare Print: "NONE". Otherwise Print: Patient’s Group #1. |
| Item 9a | Line 19 col 2 | Secondary Policy Number |
| Line 19 col 16 | Secondary Group Number | |
| Item 10a | Line 19 col 36 | If "Employment Related" is checked for this case Print: "X" |
| Line 19 col 42 | If "Employment Related" is unchecked for this case Print: "X" | |
| Item 11a | Line 19 col 51 | Primary Insured’s Date of Birth. NOTE: This will not print if the primary insurance is "Medicare" and the Patient is the Insured. |
| Line 19 col 69 | If the Primary Insured’s sex is Male Print: "X" NOTE: This will not print if the primary insurance is "Medicare" and the Patient is the Insured. | |
| Line 19 col 76 | If Primary Insured’s sex is Female Print: "X" NOTE: This will not print if the primary insurance is "Medicare" and the Patient is the Insured. | |
| Item 9b | Line 21 col 2 | Secondary Insured’s Date of Birth. |
| Line 21 col 19 | If Secondary Insured’s Sex is Male Print: "X" | |
| Line 21 col 26 | If Secondary Insured’s Sex is Female Print: "X" | |
| Item 10b | Line 21 col 36 | If Related to Accident is "Auto" Print: "X" |
| Line 21 col 42 | If Related to Accident is not "Auto" Print: "X" | |
| Line 21 col 46 | If an accident state is entered then Print: The Accident State. | |
| Item 11b | Line 21 col 51 | Primary Insured’s Employer’s Name. |
| Item 9c | Line 23 col 2 | Secondary Insured’s Employer’s Name. |
| Item 10c | Line 23 col 36 | If Related to Accident is "Yes" Print: "X" |
| Line 23 col 42 |
If Related to Accident is not "Yes" Print: "X" |
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| Item 11c | Line 23 col 51 | If the primary insurance type is not "Medicare" Print: Primary Insurance’s Plan Name. |
| Item 9d | Line 25 col 2 | Secondary Insurance’s Plan Name. |
| Item 10d | Line 25 col 31 | Local Use A |
| Item 11d | Line 25 col 53 | If a secondary insurance carrier exists for this case Print: "X" |
| Line 25 col 58 | If a secondary insurance carrier does not exist Print: "X" | |
| Item 12 | Line 28 col 7 | If the patients "Signature on File" item is checked Print: "Signature on File" |
| Line 28 col 37 | If the patients "Signature on File" item is checked and the patients Signature on File Date is not blank then Print: Signature on File Date. Otherwise Print: Today’s Date | |
| Item 13 | Line 28 col 56 | If the primary insured’s "Signature on File" item is checked Print: "Signature on File" |
| Item 14 | Line 31 col 1 | Date of Injury/Illness |
| Item 15 | Line 31 col 31 | Date Similar Symptoms |
| Item 16 | Line 31 col 55 | Date Unable to Work From |
| Line 31 col 69 | Date Unable to Work To | |
| Item 17 | Line 33 col 2 | Referring Provider’s First Name (Space) Middle Initial (Space) Last Name (Space) Credentials. |
| Item 17a | Line 33 col 29 | Referring Provider’s UPIN |
| Item 18 | Line 33 col 55 | Hospital Date From |
| Line 33 col 69 | Hospital Date To | |
| Item 19 | Line 35 col 2 | Local Use B |
| Item 20 | Line 35 col 53 | If the Outside Lab Work item is checked in the Case file Print: "X" |
| Line 35 col 58 | If this item is not checked Print: "X" | |
| Line 35 col 68 | If Outside Lab Work is checked Print: Lab charges. | |
| Item 21 | Line 37 col 4 | Diagnosis 1 |
| Line 37 col 32 | Diagnosis 3 | |
| Item 22 | Line 37 col 51 | Medicaid Resubmission No. |
| Line 37 col 62 | Medicaid Original Ref No. | |
| Item 21 | Line 39 col 4 | Diagnosis 2 |
| Line 39 col 32 | Diagnosis 4 | |
| Item 23 | Line 39 col 51 | Prior Authorization No. |
| Item 24 | Line 43, 45, 47, 49, 51, 53 | |
| Item 24a | col 2 | Transaction Date From |
| col 11 | Transaction Date To | |
| Item 24b | col 20 | Transaction Place of Service |
| Item 24c | col 23 | Transaction Type of Service |
| Item 24d | col 26 |
If the primary insurance company procedure code set is "1" Print: Procedure code #1. If code set "2" is selected Print: Procedure code #2. If code set "3" is selected Print: Procedure code #3 |
| col 33 | Modifier 1 | |
| col 35 | Modifier 2 | |
| col 37 | Modifier 3 | |
| col 39 | Modifier 4 | |
| Item 24e | col 44 | If the transaction diagnosis 1 item is checked Print: "1" |
| col 45 | If the transaction diagnosis 2 item is checked Print: "2" | |
| col 46 | If the transaction diagnosis 3 item is checked Print: "3" | |
| col 47 | If the transaction diagnosis 4 item is checked Print: "4" | |
| Item 24f | col 58 | Transaction amount |
| Item 24g | col 61 | If the practice type is Anesthesia and the transaction minutes are not blank Print: Transaction’s minutes. Otherwise Print: Transaction units |
| Item 24h | col 64 | If EPSDT is checked in the case file Print: "X" |
| Item 24i | col 67 | If Emergency is checked in the case file Print: "X" |
| Item 24j | Blank | |
| Item 24k | col 72 - Lines 43, 45, 47, 49, 51, 53 | If the primary insurance’s Print PINs on Forms is "Provider Name and PINs" or "PIN only" Print: the Insurance Type’s Pin Number from the Transaction Provider Pin Numbers |
| Item 24k | col 72 - Lines 44, 46, 48, 50, 52, 54 | If the primary insurance’s Print PINs on Forms is "Provider Name and PINs" Print: The Transaction Provider’s First Name (Space )Last Name (Space) Middle Initial. Note: will only go up to col 80. |
| Item 25 | Line 55 col 2 | The claim provider’s SSN or Fed Tax ID |
| Line 55 col 18 | If the claim provider’s Federal Tax ID Indicator is not checked Print: "X" | |
| Line 55 col 20 | If the claim provider’s Federal Tax ID Indicator is checked Print: "X" | |
| Item 26 | Line 55 col 24 | Patient’s Chart Number |
| Item 27 | Line 55 col 39 | If case Policy 1 -- Accept Assignment Transaction Default is checked Print: "X" |
| Line 55 col 44 | If case Policy 1 – Accept Assignment Transaction Default is not checked Print: "X" | |
| Item 28 | Line 55 Right Justify | Total Charges for the form |
| Item 29 | Line 55 | Blank |
| Item 30 | Line 55 Right Justify | Total Charges for the form |
| Item 33 | Line 56 col 50 | Claim Provider’s Phone Number |
| Item 31 | Line 57 | Blank |
| Item 32 | Line 57 col 24 | Facility ID |
| Item 33 | Line 57 col 51 | If the insurance type is "Medicare" and a group number is entered in either the Medicare Group Number field or the Group Number field in the Transaction Provider File then Print: Practice Name. Otherwise Print: Claim Provider’s First Name (Space) Middle Initial (Space) Last Name (Space) Credentials. |
| Item 31 | Line 58 col 2 | If the primary insurance company’s Signature on File is "Print Name" and the claim provider’s Signature item is checked Print: Claim Provider’s First Name (Space) Middle Initial (Space) Last Name (Space) Credentials. Otherwise if the provider’s Signature item is checked Print: "Signature on File" |
| Item 32 | Line 58 col 24 | Facility Name |
| Item 33 | Line 58 col 51 | If the insurance type is "Medicare" and a group number is entered in either the Medicare Group Number field or the Group Number field in the Transaction Provider File then Print: Practice Street. Otherwise Print: Claim Provider Street 1 |
| Item 31 | Line 59 col 15 | If the claim provider’s Signature item is checked and the Provider’s Signature on File Date is not blank then Print: Provider’s Signature on File. Otherwise Print: Today’s Date |
| Item 32 | Line 59 col 24 | Facility Street #1 |
| Item 33 | Line 59 col 51 | If the insurance type is "Medicare" and a group number is entered in either the Medicare Group Number field or the Group Number field in the Transaction Provider File then Print: Practice City (Space) State (Space) Zip. Otherwise Print: Claim Provider City (Space) State (Space) Zip |
| Item 32 | Line 60 col 24 | Facility City (Space) State (Space) Zip |
| Item 33 | Line 60 col 53 | If "Practice ID" is not blank in the insurance file Print: Practice ID. Otherwise Print: Claim Provider Insurance Pin Number. |
| Line 60 col 68 | Claim Provider Group Number. |
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