Printing a Referring Provider UPIN on HCFA Claim Forms

If you want a referring provider UPIN (or a Mainecare number) to print in box 17a of the HCFA claim forms or the electronic equivalent, do the following:

1. Maintain a Referral Source Code during Referral Maintenance that has the Form Type UPIN to print in box 17a.

2. When entering a charge during Charge Entry, maintain a valid Referral Source Code as the referral.  

3. When third-party claim forms are generated, the Form Type UPIN will print in box 17a of the HCFA claim forms or the electronic equivalent.