Box 15. - OTHER DATE


Note: CH 26 of the Medicare billing manual says leave blank.

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*Need to be on 3/26/14 or above (Paper & PrtCap).

ECL only does date as MMDDYY

3/26/14 and above: The Medicare/Medicaid & Disability/Hospitalization tabs have been combined into one tab labeled Dates / Specialty / CMS. In the lower rht corner, in the CMS 1500 defaults area, there are dropdown boxes to allow you to override boxes 14 & 15 on the new 02/12 CMS 1500 form (paper & PrtCap).

On the payer 'Printed Claims Options' tab, there have been four chk boxes added so you can choose whether the entire field, or just a date (without the qualifier) will appear. (This allows you, for example, to suppress qualifiers for all your Medicare patients by updating the appropriate fields added to the Printed Claim Options tab).

On the Dates / Specialty / CMS tab, choose the date type you want to enter, make sure that correct date box is populated, Qualifier will automatically be entered.

Box 15: 454 Initial Treatment - Cond | First consulted date (DEFAULT)
304 Latest Visit - Dates / Specialty / CMS tab | Last seen by supv. physician
453 Acute Manifestation of Chronic Condition - Dates / Specialty / CMS tab | complicated condition onset
439 Accident - Cond | Illness/injury occurred (*you do not have to choose an accident type. See box 10) )(ANSI - MUST check accident auto or other)
455 Last x-ray - Dates / Specialty / CMS tab | Last x-ray date
471 Prescription - ECL doesn't do
090 Report Start (Assumed Care Date) - ECL doesn't do
091 Report End (Relinquished Care Date)- ECL doesn't do
444 First Visit or Consultation - Cond | First consulted date [The title of this is probably in err. A DTP*444 in ANSI is PROPERTY & CASUALITY FIRST CONTACT date].


Note - Medicare: Needs 'Cond | Illness/injury occurred'; OR 'Condition | First Consulted' on the Printed Claims Options tab, chk boxes... 'No Qualifier in CMS-1500 2/12 box 14' and 'Leave CMS-1500 2/12 box 15 blank' (see box 14).

Note - Clearing house may tell them dates in box 14 & 15 have to be same; see box 14.