# CMS Form 1500 2/12 Item Number 17

**URL:** <https://community.open-emr.org/t/cms-form-1500-2-12-item-number-17/1353>\
**Category:** Management and Administration\
**Created:** [March 26, 2014, 4:42pm UTC](https://community.open-emr.org/t/cms-form-1500-2-12-item-number-17/1353 "2014-03-26T16:42:13Z")\
**Posts on this page:** 20\
**Page:** 1

<div class="post-metadata">

**Author:** ![system](https://discourse-uploads-openemr.s3.dualstack.us-east-1.amazonaws.com/original/2X/b/bb9e4e8ae2ea7faac2e952fd9e38a3ce03aac403.png) [@system](https://community.open-emr.org/u/system)\
**Post date:** [March 26, 2014, 4:42pm UTC](https://community.open-emr.org/t/cms-form-1500-2-12-item-number-17/1353/1 "2014-03-26T16:42:13Z")

</div>

**[nursejeff](https://sourceforge.net/u/nursejeff/)** wrote on [Wednesday, March 26, 2014](https://sourceforge.net/p/openemr/discussion/202505/thread/8c2d0999/#6d21):

Box 17 now requires a qualifier be applied to identify which provider is being reported.

```
DN Referring Provider
DK Ordering Provider
DQ Supervising Provider

```

This allows for 2 characters to the left of the dotted line and 24 characters to the right

For example: DK|Jeff Guillory RN FNP

Does OpenEMR allow for this Qualifier?

Jeff Guillory Jr  
NP Health Clinic

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<div class="post-metadata">

**Author:** ![system](https://discourse-uploads-openemr.s3.dualstack.us-east-1.amazonaws.com/original/2X/b/bb9e4e8ae2ea7faac2e952fd9e38a3ce03aac403.png) [@system](https://community.open-emr.org/u/system)\
**Post date:** [March 26, 2014, 5:36pm UTC](https://community.open-emr.org/t/cms-form-1500-2-12-item-number-17/1353/2 "2014-03-26T17:36:33Z")

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**[fsgl](https://sourceforge.net/u/fsgl/)** wrote on [Wednesday, March 26, 2014](https://sourceforge.net/p/openemr/discussion/202505/thread/8c2d0999/#ea14):

Page 11 of [this CMS guide](http://www.google.com/url?sa=t&rct=j&q=&esrc=s&source=web&cd=2&ved=0CC0QFjAB&url=http%3A%2F%2Fwww.cms.gov%2FRegulations-and-Guidance%2FGuidance%2FTransmittals%2FDownloads%2FR2842CP.pdf&ei=MA4zU_XRIdTKsQS_joIo&usg=AFQjCNHUKpj6rB-8Dy5RbOqcGrzuAUupig&bvm=bv.63738703,d.cWc) gives details about these qualifiers.

Because Kevin reworked the CMS 1500 form, we need his input.

---

<div class="post-metadata">

**Author:** ![system](https://discourse-uploads-openemr.s3.dualstack.us-east-1.amazonaws.com/original/2X/b/bb9e4e8ae2ea7faac2e952fd9e38a3ce03aac403.png) [@system](https://community.open-emr.org/u/system)\
**Post date:** [March 26, 2014, 6:14pm UTC](https://community.open-emr.org/t/cms-form-1500-2-12-item-number-17/1353/3 "2014-03-26T18:14:13Z")

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**[fsgl](https://sourceforge.net/u/fsgl/)** wrote on [Wednesday, March 26, 2014](https://sourceforge.net/p/openemr/discussion/202505/thread/8c2d0999/#6047):

Just looked in the 4.1.2 (5) Demo. There are no provisions in Misc Billing Options HCFA when Global/Features setting changed to 02/12.

Would suggest filing 837’s in the interim.

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<div class="post-metadata">

**Author:** ![system](https://discourse-uploads-openemr.s3.dualstack.us-east-1.amazonaws.com/original/2X/b/bb9e4e8ae2ea7faac2e952fd9e38a3ce03aac403.png) [@system](https://community.open-emr.org/u/system)\
**Post date:** [March 27, 2014, 6:23pm UTC](https://community.open-emr.org/t/cms-form-1500-2-12-item-number-17/1353/4 "2014-03-27T18:23:08Z")

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**[yehster](https://sourceforge.net/u/yehster/)** wrote on [Thursday, March 27, 2014](https://sourceforge.net/p/openemr/discussion/202505/thread/8c2d0999/#b594):

Seems like an oversight on my part. Out of town right now, but will look at it early next week.

---

<div class="post-metadata">

**Author:** ![system](https://discourse-uploads-openemr.s3.dualstack.us-east-1.amazonaws.com/original/2X/b/bb9e4e8ae2ea7faac2e952fd9e38a3ce03aac403.png) [@system](https://community.open-emr.org/u/system)\
**Post date:** [April 11, 2014, 3:09pm UTC](https://community.open-emr.org/t/cms-form-1500-2-12-item-number-17/1353/5 "2014-04-11T15:09:15Z")

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**[cmswest](https://sourceforge.net/u/cmswest/)** wrote on [Friday, April 11, 2014](https://sourceforge.net/p/openemr/discussion/202505/thread/8c2d0999/#6d21/d4aa):

if you need a quick patch just for your DK add this to line 375

```
put_hcfa(34, 1, 3, "DK");

```

and change line 379 to this:

```
put_hcfa(34, 4, 25, $tmp);
```

---

<div class="post-metadata">

**Author:** ![system](https://discourse-uploads-openemr.s3.dualstack.us-east-1.amazonaws.com/original/2X/b/bb9e4e8ae2ea7faac2e952fd9e38a3ce03aac403.png) [@system](https://community.open-emr.org/u/system)\
**Post date:** [April 11, 2014, 4:22pm UTC](https://community.open-emr.org/t/cms-form-1500-2-12-item-number-17/1353/6 "2014-04-11T16:22:45Z")

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**[fsgl](https://sourceforge.net/u/fsgl/)** wrote on [Friday, April 11, 2014](https://sourceforge.net/p/openemr/discussion/202505/thread/8c2d0999/#1121):

Thank you, Stephen.

I presume that the gen\_hcfa\_1500\_02\_12.inc.php will grab the new data for Box 17 from the old inc.php file.

Are the insertions correct?

---

<div class="post-metadata">

**Author:** ![system](https://discourse-uploads-openemr.s3.dualstack.us-east-1.amazonaws.com/original/2X/b/bb9e4e8ae2ea7faac2e952fd9e38a3ce03aac403.png) [@system](https://community.open-emr.org/u/system)\
**Post date:** [April 15, 2014, 9:11pm UTC](https://community.open-emr.org/t/cms-form-1500-2-12-item-number-17/1353/7 "2014-04-15T21:11:53Z")

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**[nursejeff](https://sourceforge.net/u/nursejeff/)** wrote on [Tuesday, April 15, 2014](https://sourceforge.net/p/openemr/discussion/202505/thread/8c2d0999/#ff21):

The issue I have is that my Supervising Provider is not populating in Box 17 at all.

My billing specialist is telling me that only the “referring provider” is showing up in box 17. In my case, these two are not the same person.

I need the “Supervising” physician, selected on the Fee Sheet, to show up in box 17 on my CMS1500 with the proper qualifier preceding it.

Jeff Guillory Jr.  
NP Health Clinic

---

<div class="post-metadata">

**Author:** ![system](https://discourse-uploads-openemr.s3.dualstack.us-east-1.amazonaws.com/original/2X/b/bb9e4e8ae2ea7faac2e952fd9e38a3ce03aac403.png) [@system](https://community.open-emr.org/u/system)\
**Post date:** [April 15, 2014, 11:30pm UTC](https://community.open-emr.org/t/cms-form-1500-2-12-item-number-17/1353/8 "2014-04-15T23:30:40Z")

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**[cmswest](https://sourceforge.net/u/cmswest/)** wrote on [Tuesday, April 15, 2014](https://sourceforge.net/p/openemr/discussion/202505/thread/8c2d0999/#3988):

oh, this can get tricky, following the above referenced pdf, thanks to fsgl’s link to the cms guide, you will need 2 hcfas if there’s a referring provider and a rendering provider!

there’s no easy way to handle this in openemr right now so my advice is to electronically bill it!

but if you can’t first generate the claim for the referring physician and then go back in and change the fee sheet to indicate a supervising phys and then generate that claim

to do this you’ll have to add this code:  
if ($claim-\>supervisorNPI()) {  
$tmp = $claim-\>supervisorLastName() . ', ’ . $claim-\>supervisorFirstName();  
put\_hcfa(34, 1, 3, “DQ”);  
put\_hcfa(34, 4, 25, $tmp);  
put\_hcfa(34,33,15, $claim-\>supervisorNPI());  
}

here

> <https://github.com/openemr/openemr/blob/master/library/gen_hcfa_1500.inc.php#L394>

---

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**Author:** ![system](https://discourse-uploads-openemr.s3.dualstack.us-east-1.amazonaws.com/original/2X/b/bb9e4e8ae2ea7faac2e952fd9e38a3ce03aac403.png) [@system](https://community.open-emr.org/u/system)\
**Post date:** [April 16, 2014, 4:44pm UTC](https://community.open-emr.org/t/cms-form-1500-2-12-item-number-17/1353/9 "2014-04-16T16:44:50Z")

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**[fsgl](https://sourceforge.net/u/fsgl/)** wrote on [Wednesday, April 16, 2014](https://sourceforge.net/p/openemr/discussion/202505/thread/8c2d0999/#6b53):

Very difficult indeed.

Because there are only 3 boxes for 6 entries, how would the Billing Manager “know” whether to insert the info for referring or for supervising **or** to generate a CMS 1500 for referring and then for supervising?

If the CPT codes are the same for both referring and supervising on the same claim form, it would be a lot simpler to use one or the other. If the practice is not going to get paid more for using both, then there appears to be no reason to use both.

The only time that I think of using supervising is when attending physicians in a residency program are the supervisors and the residents are the renderers.

Jeff, why do you need both and why is it not possible to send 837’s? If we understand your situation better, we can come up with a better solution.

---

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**Author:** ![system](https://discourse-uploads-openemr.s3.dualstack.us-east-1.amazonaws.com/original/2X/b/bb9e4e8ae2ea7faac2e952fd9e38a3ce03aac403.png) [@system](https://community.open-emr.org/u/system)\
**Post date:** [June 18, 2014, 3:24pm UTC](https://community.open-emr.org/t/cms-form-1500-2-12-item-number-17/1353/10 "2014-06-18T15:24:11Z")

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**[jkshla](https://sourceforge.net/u/jkshla/)** wrote on [Wednesday, June 18, 2014](https://sourceforge.net/p/openemr/discussion/202505/thread/8c2d0999/#1121/cda8):

I need to make these insertions as well. I was hoping patch 6 would give an option in Misc billing for this. Can someone walk me through the process of making these changes? I am comfortable doing it but need a little guidance. Thanks

---

<div class="post-metadata">

**Author:** ![system](https://discourse-uploads-openemr.s3.dualstack.us-east-1.amazonaws.com/original/2X/b/bb9e4e8ae2ea7faac2e952fd9e38a3ce03aac403.png) [@system](https://community.open-emr.org/u/system)\
**Post date:** [June 18, 2014, 5:30pm UTC](https://community.open-emr.org/t/cms-form-1500-2-12-item-number-17/1353/11 "2014-06-18T17:30:29Z")

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**[fsgl](https://sourceforge.net/u/fsgl/)** wrote on [Wednesday, June 18, 2014](https://sourceforge.net/p/openemr/discussion/202505/thread/8c2d0999/#6392):

Hi James,

This should have been fixed with patch 6.

Go to Administration/Globals/Features, then to the bottom of the screen to choose the 02/12 version of the CMS 1500 form.

You can experiment in the [2099 Demo](http://demo.open-emr.org:2099/openemr/interface/login/login_frame.php?site=default) before printing up your real claims.

Bear in mind there is no way to have both DN and DQ on the same form. The CMS guide cited above instructs the submitter to send two paper claims, because there is physically no place for the second qualifer. If you don’t want to submit two forms for the same claim, try sending the claim electronically. I think that the 837P should be able to accommodate both.

---

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**Author:** ![system](https://discourse-uploads-openemr.s3.dualstack.us-east-1.amazonaws.com/original/2X/b/bb9e4e8ae2ea7faac2e952fd9e38a3ce03aac403.png) [@system](https://community.open-emr.org/u/system)\
**Post date:** [June 18, 2014, 5:46pm UTC](https://community.open-emr.org/t/cms-form-1500-2-12-item-number-17/1353/12 "2014-06-18T17:46:10Z")

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**[fsgl](https://sourceforge.net/u/fsgl/)** wrote on [Wednesday, June 18, 2014](https://sourceforge.net/p/openemr/discussion/202505/thread/8c2d0999/#8514):

The DN should appear in the claim form if a referring physician had been selected in the Demographics/Choices. See attachment 1.

DQ should appear if designated in the Fee Sheet. See attachment 2.

Referring and Supervising physicians must be in the Address Book first in order for this to work on 2 claim forms.

---

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**Author:** ![system](https://discourse-uploads-openemr.s3.dualstack.us-east-1.amazonaws.com/original/2X/b/bb9e4e8ae2ea7faac2e952fd9e38a3ce03aac403.png) [@system](https://community.open-emr.org/u/system)\
**Post date:** [June 21, 2014, 7:39pm UTC](https://community.open-emr.org/t/cms-form-1500-2-12-item-number-17/1353/13 "2014-06-21T19:39:40Z")

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**[jkshla](https://sourceforge.net/u/jkshla/)** wrote on [Saturday, June 21, 2014](https://sourceforge.net/p/openemr/discussion/202505/thread/8c2d0999/#5316):

fsgl. I have everything configured properly. I have updated to patch 7 now and still can’t get it to work. I need DN only. I am listed in the address book and as the referring provider in choices. Claim form is still not generating the DN in box 17. It only shows my name as it did prior. I have had it set on claim forms 02/12 in features for some time and just verified that it is in place as well. Any ideas? Thanks

---

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**Author:** ![system](https://discourse-uploads-openemr.s3.dualstack.us-east-1.amazonaws.com/original/2X/b/bb9e4e8ae2ea7faac2e952fd9e38a3ce03aac403.png) [@system](https://community.open-emr.org/u/system)\
**Post date:** [June 21, 2014, 8:14pm UTC](https://community.open-emr.org/t/cms-form-1500-2-12-item-number-17/1353/14 "2014-06-21T20:14:56Z")

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**[cmswest](https://sourceforge.net/u/cmswest/)** wrote on [Saturday, June 21, 2014](https://sourceforge.net/p/openemr/discussion/202505/thread/8c2d0999/#a195):

right, the DN hasn’t been added to the code base yet

follow my post above from 04-11, you’ll be editing the box 17 section of

library/gen\_hcfa\_1500.inc.php

---

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**Author:** ![system](https://discourse-uploads-openemr.s3.dualstack.us-east-1.amazonaws.com/original/2X/b/bb9e4e8ae2ea7faac2e952fd9e38a3ce03aac403.png) [@system](https://community.open-emr.org/u/system)\
**Post date:** [June 21, 2014, 8:21pm UTC](https://community.open-emr.org/t/cms-form-1500-2-12-item-number-17/1353/15 "2014-06-21T20:21:00Z")

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**[jkshla](https://sourceforge.net/u/jkshla/)** wrote on [Saturday, June 21, 2014](https://sourceforge.net/p/openemr/discussion/202505/thread/8c2d0999/#9417):

can you give me a quick tutorial of how to edit that on the server. I plenty compenent to do it if you can get me to the right file. I’ll need commands. I’m new to Linux. Thanks!

---

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**Author:** ![system](https://discourse-uploads-openemr.s3.dualstack.us-east-1.amazonaws.com/original/2X/b/bb9e4e8ae2ea7faac2e952fd9e38a3ce03aac403.png) [@system](https://community.open-emr.org/u/system)\
**Post date:** [June 21, 2014, 8:35pm UTC](https://community.open-emr.org/t/cms-form-1500-2-12-item-number-17/1353/16 "2014-06-21T20:35:50Z")

</div>

**[fsgl](https://sourceforge.net/u/fsgl/)** wrote on [Saturday, June 21, 2014](https://sourceforge.net/p/openemr/discussion/202505/thread/8c2d0999/#3db8):

The path in Linux is var/www/openemr/library/gen\_hcfa\_1500.inc.php and open as Administrator.

See the screenshot in my 4/11 post.

Add line 375, use DN, not DK.

Change line 379.

Install Bluefish if you cannot get the line numbers in Scite.

---

<div class="post-metadata">

**Author:** ![system](https://discourse-uploads-openemr.s3.dualstack.us-east-1.amazonaws.com/original/2X/b/bb9e4e8ae2ea7faac2e952fd9e38a3ce03aac403.png) [@system](https://community.open-emr.org/u/system)\
**Post date:** [June 21, 2014, 8:44pm UTC](https://community.open-emr.org/t/cms-form-1500-2-12-item-number-17/1353/17 "2014-06-21T20:44:58Z")

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**[fsgl](https://sourceforge.net/u/fsgl/)** wrote on [Saturday, June 21, 2014](https://sourceforge.net/p/openemr/discussion/202505/thread/8c2d0999/#62d4):

Any reason to submit paper claims?

One does not have to fool around with these qualifiers with the 837P.

Turnaround time for payment is about 2 weeks for e-claims while our Medicare carrier takes about 6-7 weeks to pay on paper claims.

---

<div class="post-metadata">

**Author:** ![system](https://discourse-uploads-openemr.s3.dualstack.us-east-1.amazonaws.com/original/2X/b/bb9e4e8ae2ea7faac2e952fd9e38a3ce03aac403.png) [@system](https://community.open-emr.org/u/system)\
**Post date:** [June 21, 2014, 8:51pm UTC](https://community.open-emr.org/t/cms-form-1500-2-12-item-number-17/1353/18 "2014-06-21T20:51:48Z")

</div>

**[jkshla](https://sourceforge.net/u/jkshla/)** wrote on [Saturday, June 21, 2014](https://sourceforge.net/p/openemr/discussion/202505/thread/8c2d0999/#ec92):

Paper claims are for secondary insurance. We have to send primary EOBs with them.

---

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**Author:** ![system](https://discourse-uploads-openemr.s3.dualstack.us-east-1.amazonaws.com/original/2X/b/bb9e4e8ae2ea7faac2e952fd9e38a3ce03aac403.png) [@system](https://community.open-emr.org/u/system)\
**Post date:** [June 21, 2014, 8:59pm UTC](https://community.open-emr.org/t/cms-form-1500-2-12-item-number-17/1353/19 "2014-06-21T20:59:18Z")

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**[jkshla](https://sourceforge.net/u/jkshla/)** wrote on [Saturday, June 21, 2014](https://sourceforge.net/p/openemr/discussion/202505/thread/8c2d0999/#9f20):

Also, what command should precede the path to open. As administrator I assume you are referring to sudo?

---

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**Author:** ![system](https://discourse-uploads-openemr.s3.dualstack.us-east-1.amazonaws.com/original/2X/b/bb9e4e8ae2ea7faac2e952fd9e38a3ce03aac403.png) [@system](https://community.open-emr.org/u/system)\
**Post date:** [June 21, 2014, 9:03pm UTC](https://community.open-emr.org/t/cms-form-1500-2-12-item-number-17/1353/20 "2014-06-21T21:03:37Z")

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**[fsgl](https://sourceforge.net/u/fsgl/)** wrote on [Saturday, June 21, 2014](https://sourceforge.net/p/openemr/discussion/202505/thread/8c2d0999/#ec92/a41b):

EOB’s from the primary insurances are sent as part of the 837P file. Occasionally the EOB’s are not transmitted as a result of an error. In those unusual circumstances, we would just fax a copy of the missing EOB to the secondary. This saves us from having to resubmit to the secondary again.

[Next page](https://community.open-emr.org/t/cms-form-1500-2-12-item-number-17/1353.md?page=2)