HCFA-1500 Box 17 - Name of Referring Provider or Other Source
August 03, 2025Learn how to complete HCFA-1500 Box 17, which captures the referring, ordering, or supervising provider’s name. Includes qualifier codes (DN, DK, DQ) and how this maps to the X12 837 electronic format loops 2310A, 2310D, and 2420E.
HCFA-1500 Box 16 - Dates Patient Unable to Work in Current Occupation
August 03, 2025Learn how to complete Box 16 of the HCFA-1500 form, which reports the dates a patient was unable to work. Includes X12 837 mapping for DTP segments 314, 360, and 361.
HCFA-1500 Box 15 - Other Date
August 03, 2025Box 15 on the HCFA-1500 form captures additional relevant dates like the initial treatment date or acute manifestation of a chronic condition. Learn how it maps to the X12 837 format.
HCFA-1500 Box 14 - Date of Current Illness, Injury, Pregnancy (LMP)
August 02, 2025Learn how to complete Box 14 on the HCFA-1500 form, including proper formatting of dates and qualifiers like 431 and 484, and how this data maps to the X12 837 DTP segment.
HCFA-1500 Box 13 - Insured's or Authorized Person's Signature
July 31, 2025Learn how Box 13 of the HCFA-1500 form maps to the CLM08 segment in the X12 837 transaction. Understand how 'SIGNATURE ON FILE' translates to a valid assignment of benefits code.