HCFA 1500 Problematic Fields for DOL claims

Box 1a or11 –Claimant Case Number Claimant Case Number
Boxes 12 & 13 Boxes 12 & 13 –““Signature on File Signature on File””
Box 21 Box 21 –ICDICD-9 Diagnosis Codes 9 Diagnosis Codes
Box 24A Box 24A –Dates of Service Dates of Service
Box 24D Box 24D –CPT/HCPCS Procedure Codes CPT/HCPCS Procedure Codes and modifiers if applicable and modifiers if applicable
Box 24E –Diagnosis pointers Diagnosis pointers
Box 24F –Line Charges Line Charges
Box 24G –Units
Box 25 –Provider’’s Federal Tax ID #s Federal Tax ID #
Box 28 –Total Charge
Box 31 –Signature of physician and bill Signature of physician and bill date

BOX 31 -Treating Provider
Appropriate signatureAppropriate signature
Bill date must be after last date of service Bill date must be after last date of service

BOX 32 -Service Address
Address where service was rendered Address where service was rendered
To include Zip CodeTo include Zip Code

BOX 33 -Billing Address
Address where payment is sent Address where payment is sent
Provider number attained after enrollment Provider number attained after enrollment 
From a provider perspective this is the most important field on a HCFA. This information is vital to pay the correct provider.