HCFA 1500 Box 17 - How do I print the referring/supervising provider's information

There are 2 different ways to print the referring provider's information in box 17 on the HCFA 1500 form.

    • Persistent - You can enter into the patient's demographics so that it will appear on all of the patient's future appointments without having to reenter the information on each claim.
    • Claim Specific - You can enter the information at the claim level. The information will only appear on that claim and will need to be reentered if applicable on future claims.

Persistent

Adding the referring provider to your contacts

** Note** If you have already added the referring provider to your contacts, please skip to the adding to the patient's demographic section below.

1) Please click on the message center (envelope icon) towards the top right corner of your screen.

2) On the left panel, please select Contacts which is located below the Referrals heading, and then click on +New (Towards the top right).

3) In the New Referral Contact screen, enter the doctor's First name, Last name, Address, specialty & NPI, and click on Add Contact.

Adding to the patient's demographics

1) Hover over the Patients Tab and select Patient List.

2) Enter the Patient's Name or Chart ID in the patient search field.

3) This will direct you to the patient's demographics section.

4) In the Patient's Demographic section, click on the Demographics tab.

The fields Referring Dr. First Name and Referring Dr. Last Name will be used, and the identifier DN will be applied. If no information is available under Referring Doctor, information found under Ordering Doctor will be used instead, and the identifier DK will be applied.

17a - This item pulls from the fields Referring Dr. Qualifier and Referring Dr. Number under Referring Doctor. The identifiers for this item are as follows, and come from the selection in Referring Dr. Qualifier:

0B State License Number
1G Provider UPIN Number
G2 Provider Commercial Number

17b - This item pulls from the Referring Dr. NPI Number, or if no Referring Dr. data is present, Ordering Dr. NPI Number.

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5) Scroll down to the Referring Doctor section and enter the doctor's name in the Referring Doctor Search field.

6) Once you enter the referring doctor's information, please scroll down and click on Save Demographics.

Supervising provider information can be shown by marking off Display the claim's supervising provider in box 17. (Figure 6) This option can be found in Account Settings > Billing. Selecting this option will cause box 17 to pull data from the supervising provider’s information, once a supervisor is selected in the Appointment details. Relevant information for that supervising provider is First Name, Last Name, and Rendering Provider NPI - this information will be pulled from that provider’s DrChrono Account Settings.

Figure 6 - Go to Account > Provider Settings > Medical Billing

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***Please note that Box 17 will not update if the demographics of the patient chart are updated AFTER the appointment is scheduled.***

Claim Specific

** Note** If the provider is not already listed in your contacts, please follow the directions above to add them before proceeding.

1) In the Live Claims Feed, pull up the patient's appointment to which you would like to add the referring information.

2) In the right column, at the bottom, you will see an option for Provider. Click on the pencil icon.

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3) You will then be given a window to add the referring provider. Once they are loaded as a contact, you can type their name or a portion of their name in the Contact Search box and when you select the provider, all of their demographic information will be pulled over.

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