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Updated on: Dec 07, 2022
Scenario C: Referring Provider Legacy ID (when an External Provider is listed as the Referring Provider)
This lesson describes the workflow for adding a legacy ID for a Referring Provider in Block 17a onto the CMS 1500 claim.
External providers will need to be set up as a Contact in the Contacts dialog. To access the Contacts dialog, go to the Tools menu and select Contacts.
If an Internal Provider must be listed as the Referring Provider on a claim AND must have a legacy ID indicated (that is other than their Taxonomy code), the Internal Provider will need to be set up as a Contact, as well. Follow the instructions below to indicate the Legacy ID for a Contact.
Manual CMS 1500 (08/05) Crosswalk -
Updated on: Dec 07, 2022
Scenario B: Referring Provider Legacy ID (when an Internal Provider is listed as the Referring Provider)
This lesson describes the workflow for adding a legacy ID for a Referring Provider in Block 17a onto the CMS 1500 claim.
If an Internal Provider must be listed as the Referring Provider on a claim AND must have a legacy ID indicated (that is other than their Taxonomy code), the Internal Provider can be set up as a Contact, as well. Follow the instructions below to indicate the Legacy ID for a Contact.
Manual CMS 1500 (08/05) Crosswalk -
Updated on: Dec 07, 2022
Scenario A: Referring Provider Legacy ID (Defaulting Taxonomy code for an Internal Provider listed as the Referring Provider)
This lesson describes the workflow for having the taxonomy code for an internal provider, who is listed as the Referring Provider, populate Block 17a on the CMS 1500 claim.
If an Internal Provider must be listed as the Referring Provider on a claim AND must have a legacy ID indicated (that is other than their Taxonomy code), the Internal Provider will need to be set up as a Contact, as well. See Lesson 2b for instructions to set up that scenario.
Manual CMS 1500 (08/05) Crosswalk -
Updated on: Dec 07, 2022
1. Referring Provider Legacy ID: Indicating the Referring Provider on the claim
Pulling the Referring Provider legacy qualifier and ID.
Manual CMS 1500 (08/05) Crosswalk -
Updated on: Dec 07, 2022
Referring Provider Name
Indicating the Referring Provider for a visit.
Manual CMS 1500 (08/05) Crosswalk -
Updated on: Dec 07, 2022
Dates Patient Unable to Work
Indicating unable to work dates.
Manual CMS 1500 (08/05) Crosswalk -
Updated on: Dec 07, 2022
Same or Similar Illness
If the patient has had the same or similar illness, give the first date of illness.
Manual CMS 1500 (08/05) Crosswalk -
Updated on: Dec 07, 2022
Date of Current: (Illness, Injury or Pregnancy)
Indicating the date of one of the following: Illness (First symptom), Injury (Accident) or Pregnancy (LMP)
Manual CMS 1500 (08/05) Crosswalk -
Updated on: Dec 07, 2022
Insured Signature
Insured's or Authorized Person's Signature
Manual CMS 1500 (08/05) Crosswalk -
Updated on: Dec 07, 2022
Patient Signature
Patient or Authorized Signature
Manual CMS 1500 (08/05) Crosswalk