How to fill in the HCFA form

If you are wondering where to fill out the HCFA form information, below are steps on where in your drchrono account to fill out particular boxes on the HCFA form. Once this information is updated, you will be able to view these changes on the HCFA form. 
Box 12 and 13
In order to add a signature on file you will need to go into Patients Chart > Demographics tab > Scroll to the bottom > Signature on file > Save 
Please note that this field will automatically update to "Consent On File" if the patient has signed the HIPAA Data Use Agreement when checking in on the Check In app or 
Box 14, 15 & 19
If you would like the last related visit to populate, go into the Patient's Chart > Demographics > Insurances > Check "Prepopulate Last Related Visit."
Box 24J & 32A
24 J: You will need to update the Billing NPI and Rendering Provider NPI here in order for it to reflect on the HCFA form by going into Account > Settings > Billing tab
32 A: If this box needs to be blank, you will need to go to Account > Office > Edit Office > Check "Use Facility NPI."

Box 25, Box 31, & Box 33

Go to Account > Settings > Billing tab. 

Box 27
If you want it to read "No", would need to uncheck the accept assignment box with a specific payer ID. Go to Billing > Insurance Set Up > Click the Pencil Button > Uncheck "Accept Assignment."

Now the HCFA form is ready to be printed and sent! 
Note: We have started displaying 15 digits patient account numbers in the HCFA form box #26. When the insurance sends the ERA or EOB, they will reference the account number which you can use to locate the appointment. In the Billing > Live Claims Feed screen > drchrono claim number field, you can enter last 9 digits of the patient account number to locate the appointment.
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