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Insurance Subscriber

Insurance Subscriber

 

See Also:

Eligibility tab

CMS-1500 Reference Manual

Insurance Carrier

 

A patient's insurance record is presented on three tabs. The first two correspond to the kinds of information they contain: Subscriber and Eligibility while the third is for your miscellaneous notes. The subscriber is also referred to as the insured.

 

 

The order fields are positioned on the screen and the order in which they are selected when you press Tab may appear illogical. However, it is a compromise between the logic of screen geometry, the logic of box numbers, and the logic of function. The descriptions below follow the tab order.

 

Fields shown with a blue background indicate required entries. You cannot complete the form until these are filled.

 

Insured's ID Number [Box 1a]

This is the subscriber's ID number assigned to them by their insurance payer.

 

Patient Relationship to Insured [Box 6]

This is the patient's relationship to the insured person stated from the patient's point of view. If the patient and the insured are the same, choose Self. If the patient and the insured are married, choose Spouse. If the patient is the insured's child, choose Child. If the patient is the insured's parent, choose Other. Placing a check in one box will remove it from another. If you click a box with a check it will clear it leaving all boxes unchecked.

 

When you press Tab to complete the insured's ID number in box 1a, you are taken to the relationship check boxes for box 6 rather than the name in box 4. This is because the behavior of the insured's name fields changes depending in whether Self is selected in box 6.

 

When the relationship to the insured is Self, the patient's name and address are filled in automatically and the fields become non-editable. When any other relationship box is selected, or no box at all, you can edit the name, address and telephone number fields.

 

Insured's Name [Box 4]

Enter the subscriber's first and last names and their middle initial.

 

Insured's Address [Box 7]

This box contains six fields:   the subscriber's street address, city, state code, zip code, telephone area code, and telephone number. If Self is selected for the relationship, these fields will be non-editable and “grayed-out” as a visual indicator that they cannot be modified.

 

Reserved for Local Use [Box 10d]

Usage of this field is not defined in the standard specification so use it according to your payer's instructions.You have 23 characters to enter whatever may be required.

 

Insured's Signature [Box 13]

If you have the insured's or their authorized representative's signature on file agreeing to allow the payer to make payments directly to you, place a check in this box. When the claim is printed and this box is checked, the signature line will then contain the text “SIGNATURE ON FILE”.

 

Reserved Local [Box 19]

There are two lines that can contain information in box 19. The top line is shorter than the bottom line (41 characters versus 57) to accommodate the box description on the form. Usage of the fields in this box is not defined in the standard specification so use it according to your payer's instructions.

 

Accept Assignment [Box 27]

If you have an agreement with this payer to accept assignment of benefits, check the Yes box. Checking Yes or No will remove the check from the other box. Clicking on a checked box will remove the check from both boxes.

 

Medicaid Resubmission Code [Box 22]

This is the original reference number for resubmitted claims. Refer to your payer's current instructions for what to enter in both the code and the original reference number fields.

 

Prior Authorization Number [Box 23]

If the payer has authorized treatment, enter the authorization number here.

 

Generate claims to this insurance

If this box is not checked, no claims will be generated based on this insurance when you do batch claims.

 

 

See Also:

Eligibility tab

CMS-1500 Reference Manual

Insurance Carrier