How do I complete Blocks 14, 15, 24C, and 32 on the HCFA 1500 form?
Block 14 – Date of Current Illness, Injury, or Pregnancy Block 15 – First Date of Previous Same or Similar Illness Blocks 14 and 15 must be completed unless the contract between the provider and health carrier states otherwise. Even when (1) patients receive preventative services absent any symptoms or signs of illness; (2) patients present with multiple diagnoses that may have begun on different dates; and (3) patients with whom physicians or their staff do not have direct contact, these required fields must be completed. It is essential that physicians ascertain whether their contracts, claims filing manuals, claims filing instructions, or clean claim element notices provide instructions regarding the completion of these fields in the event of one of the example scenarios. Absent such direction, the information that is presented to the provider at the time of the visit is paramount. When preventative care is provided and no illness is discerned, the provider may list the date of the
