HCFAFILE and HCFA11 File Map

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.

  • Dates include the four-digit year.

  • Does not bill secondary carriers other than in MediGap situations.

  • Does not print or calculate payments.

  • 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.
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"
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.