Home

Insurance Eligibility

Insurance Eligibility

 

See Also:

Subscriber tab

CMS-1500 Reference Manual

Insurance Carrier

 

 

Most of the information on this tab screen is for filling CMS-1500 boxes 9 and 11. Box 9 is for reporting other insurance primarily to allow for Coordination of Benefits (COB). You can enter the box 9 fields directly or copy them from the box 4 and 11 fields on another insurance record by clicking the Copy button. The copied information can be changed however necessary.

 

Other Insured's Name [Box 9]

When reporting other insurance, enter the other subscriber's first and last names and their middle initial. This corresponds to box 4 on claims to the other insurance.

 

Other Insured's Policy or Group [Box 9a]

When reporting other insurance, enter the other subscriber's policy or group number as it appears on the other subscriber's health care identification card. This corresponds to box 11 on claims to the other insurance.

 

Other Insured's Date of Birth [Box 9b]

When reporting other insurance, enter the other subscriber's date of birth. This corresponds to box 11a on claims to the other insurance.

 

Other Insured's Sex [Box 9b]

When reporting other insurance, select the other subscriber's sex. This corresponds to box 11a on claims to the other insurance.

 

Other Insured's Employer or School [Box 9c]

When reporting other insurance, enter the name of the other subscriber's employer or school. This corresponds to box 11b on claims to the other insurance.

 

Insurance Plan or Program Name [Box 9d]

When reporting other insurance, enter the other subscriber's insurance plan or program name. Some payers require an identification number rather than the name in this field. This corresponds to box 11c on claims to the other insurance.

 

Copy box 9 from Boxes 4 and 11 on another insurance record

Click this button to select another insurance record for this patient and use the box 4 and 11 values to fill in the box 9 values on this form.

 

Insured's Policy, Group, or FECA [Box 11]

Enter the subscriber's policy or group number as it appears on the subscriber's health care identification card.

 

Insured's Date of Birth [Box 11a]

Enter the subscriber's date of birth.

 

Insured's Sex [Box 11a]

Select the subscriber's sex.

 

Insured's Employer or School [Box 11b]

Enter the name of the subscriber's employer or school. The subscriber's employer's name or school name refers to the name of the employer or school attended by the insured.

 

Insurance Plan or Program Name [Box 11c]

Enter the subscriber's insurance plan or program name. Some payers require an identification number rather than the name in this field.

 

Is There Another Health Benefit Plan [Box 11d]

This should be marked Yes if you are filling the box 9 fields, otherwise select No.

 

Priority

This is how you indicate whether this is the patient's primary, secondary, etc. insurance. For primary insurance, enter a 1, for secondary insurance enter 2, and so forth.

 

Effective Date

Enter the date the subscriber's insurance began. You can right-click or press F2 to select a date from the popup calendar.

 

Termination Date

If the insurance coverage has ended, enter the date the subscriber's insurance ended. You can right-click or press F2 to select a date from the popup calendar.

 

 

See Also:

Subscriber tab

CMS-1500 Reference Manual

Insurance Carrier