1. Insurance: Patient Demographics > Insurance Info

    1a. Insured’s ID #: Patient Demographics > Insurance Info
2. Patient’s Name: Patient Demographics
3. Patient DOB: Patient Demographics
4. Insured’s Name: Patient Demographics > Insurance Info
5. Patient’s Address: Patient Demographics
6. Patient Relationship to Insured: Patient Demographics
7. Insured’s Address: Patient Demographics > Insurance Info
8. Reserved for NUCC use.
9. Other Insured’s Name: Patient Demographics > Insurance Info > Insured Party
    9a. Other Insured’s Policy or Group #: Patient Demographics > Insurance Info > Secondary Insurance
    9b. Reserved for NUCC use.

    9c. Reserved for NUCC use.
    9d. Insurance Plan Name of Program Name: Patient Demographics > Insurance Info > Secondary Insurance
10. Is Patient’s Condition Related To: Patient Demographics
    10d. Claim Codes (Designated by NUCC).
11. Insured’s Policy, Group of FECA #: Patient Demographics > Insurance Info
    11a. Insured’s DOB:  Patient Demographics > Insurance Info
    11b. Other Claim ID (Designated by NUCC).
    11c. Insurance Plan Name or Program Name: Patient Demographics > Insurance Info
    11d. Is there Another Health Benefit Plan? If YES, must list primary insurance as 1 and secondary as 2
12. Patient or Authorized Signature: This field will always default to “Signature on File;” you MUST keep a signed/completed patient release form (or signed HCFA form) on file.
13. Insured's or Authorized Person's Signature: See Box 12

PHYSICIAN OR SUPPLIER INFORMATION (From Box 14 to 33):

14. Date of Current Illness: Demographics > Episodes of Care
15. If Patient Has Had Same or Similar Illness, Give First Date: Demographics > Episodes of Care > “Date of Similar Illness”
16. Date Patient Unable to Work in Current Occupation: See Box 14
17. Name of Referring Provider or Other Source: Demographics > Other Contacts > Referring Provider Name
    17a. and 17b: Demographics > Other Contacts > Referring Provider NPI #
18. Hospitalization Dates Related to Current Services:  Demographics > Current Date of Hospitalization
19. Reserved for Local Use (Corrected Claim): Billing/Productivity Report > Print HCFA button > Claim Options dialogue > Replacement or Void.

20. Outside Lab?: Not used in ICANotes.
21. Diagnosis or Nature of Illness or Injury:

• Progress Note PN Pt 2 tab > Diagnosis OR
• Complete Evaluation > Finish Initial tab > 4. Diagnosis OR
• Group Therapy Note > Diagnosis (bottom-left).
  

22. Claim resubmission code: (available after Preparing in Claim Options, 7 for Replacement of Prior Claim, 8 for Void / Cancel of Prior Claim) and Original Reference / Claim Number.

23. Prior Authorization #:

• Progress Note PN Pt 2, PN (Non-Rx) or Grp. Therapy tab > Managed Care Auth # OR
• Settings and Directories > Spec. to Indiv. > Personal Info > CLIA #*

24a. Date(s) of Service: Preview Compiled Note Screen > upper-right of Note
24d. Procedures, Services, or Supplies:

• Progress Note PN Pt 2 tab > lower-right OR
• Progress Note PN (Non Rx) tab > middle-left OR
• Group Therapy Note > bottom OR
• Dietitian Note > Bottom
  

24e. Diagnosis Pointer: See Box 21
24f. See Box 24d.
24h. EPSDT Family Plan.
24j. Rendering Provider ID #:

• (pink shaded): Settings and Directories > Spec. to Indiv. > Personal Info > Taxonomy Code
  
• (white): Settings and Directories > Specific to Individual > Personal Info > Accepts Gov't Assignment > click on Group Member instead of Sole Practitioner. Must also have appropriate NPI numbers filled out for group and individual.

25. Federal Tax ID: Settings and Directories > Spec. to Indiv.
26. Patient’s Account #: Patient Demographics
27. Accept Assignment? (Gov’t Claims): Settings and Directories > Spec. to Indiv. > “For Gov’t Claims” toggle
28. Total Charge: Pulls from Billing Rate of CPT Code in 24d.
29. Amount Paid: Patient Accounts > New Service Charge > New Payment/Adj. **
30. Reserved for NUCC use.
31. Signature of Physician or Supplier Including Degrees or Credentials: Settings and Directories > Spec. to Indiv. >
Personal Info > Options > Signature at End of Note
32. Service Facility Location Info: Settings and Directories > Shared By All Staff > Sites/Letterheads
    32a. NPI:  Settings and Directories > Shared By All Staff > Sites/Letterheads > NPI for Facility
    32b. (shaded): Settings and Directories > Shared By All Staff > Sites/Letterheads > Facility Other ID
33. Billing Provider Info and PH#: Settings and Directories > Shared By All Staff > Sites/Letterheads
    33a. Billing NPI: Settings and Directories > Shared By All Staff > Sites/Letterheads > Billing NPI
    33b. Billing Other ID: See Box 32b.