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Medicare specific requirements for the HCFA 1500 claim form

Medicare has specific requirements for how they want claims submitted on the HCFA 1500 Claims forms. Below we have outlined the areas where you can enter the necessary information to satisfy these Medicare specific requirements.

Setting Up Medicare As An Insurance Co. 

When setting up Medicare as an Insurance Co. in ChiroFusion, the 'Insurance Type' must appear as 'Medicare (or Medicare Part B)' and this will satisfy the requirements of Box 1 on the HCFA 1500 Claims form. 
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Medicare and HCFA 1500 - Box 11

Medicare requires a claim form to indicate whether or not there is any other Insurance carried by the patient. If there isn't another Insurance company that is Primary to Medicare, they require the word 'None' to appear in Box 11 of the HCFA 1500 Claim form. This can be managed in your Insurance Company. settings under the HCFA 1500 tab. The word 'None' must be entered in the text field for Box 11.
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Initial Treatment Date

Medicare requires the patient's initial treatment date to appear on the HCFA 1500 Claims form, and advises that this is to go in Box 14 of the HCFA Claims form. However, when submitting claims through ChiroFusion and Office Ally, this needs to be setup differently to transmit to Medicare properly. 

Essentially, it is Box 15 that is representative of the 'Initial Treatment Date' and when used with Qualifier 454, it will be sent in the correct format and still meet the requirement that Medicare indicates as being 'Box 14'. It is the Qualifier that matters most and the proper format for Medicare patients is as follows:

  • Box 14: Onset Date of Ailment Illness and Qualifier 431

  • Box 15: Initial Treatment Date & Qualifier 454

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The above outline is in reference to Medicare standards in part and there may be other applicable requirements that can vary from case to case. We advise contacting Medicare directly when verifying Provider requirements/details for claims filing.