How to print Supervising Provider details on the HCFA-1500 form

Adding Supervising Provider Details on the HCFA-1500 Form

If you need to activate a supervising physician for your office, please reach out to your Account Manager or support. Once activated, you can print those details on your HCFA-1500 form by following the directions below.

1. From the appointment window, either from the calendar or within the Live Claims Feed, you will see an option for Supervising Provider. Selecting from either the calendar view or the Live Claims Feed will update the information in both places.

From the appointment window:

From the Live Claims Feed:

1.  Once the provider is selected from the dropdown, please save the appointment.
2. When you open the HCFA 1500,  the supervising details will show in box #17 along with the qualifier DQ.